ENDOSCOPIC SPHINCTEROPLASTY - A NOVEL AND SAFE ALTERNATIVE TO PAPILLOTOMY IN THE MANAGEMENT OF BILE-DUCT STONES

Removal of bile duct stones during endoscopic retrograde cholangiopanc reatography (ERCP) usually includes papillotomy, Papillotomy is associ ated with occasional complications and in addition, the longterm seque lae of papillotomy in young patients having laparoscopic cholecystecto my remain unclear. As an alternative to papillotomy, this study prospe ctively evaluated the efficacy and safety of endoscopic balloon sphinc teroplasty to facilitate bile duct clearance. Of 32 patients with bile duct stones (diameter 3-30 mm) at ERCP, sphincteroplasty was consider ed inappropriate in four patients because of stone size (>20 mm) neces sitating papillotomy for bile duct clearance. Spincteroplasty was perf ormed in the remaining 28 patients to permit duct clearance by dormier basket, balloon or mechanical lithotripsy. The bile duct was cleared in 22 patients (79%) while additional measures including papillotomy o r stent insertion were required in the remaining six patients (21%) be cause of stone size or technical difficulties. Thc:re was no associate d papillary haemorrhage. Pancreatitis was seen in one patient (4%) but resolved within 24 hours. Our preliminary experience suggests that sp hincteroplasty is a safe and effective sphincter preservation techniqu e that significantly reduces the necessity for papillotomy in the mana gement of bile duct stones.