EARLY COMPLICATIONS AND MEAN 8-YEAR FOLLOW-UP AFTER ENDOSCOPIC SPHINCTEROTOMY IN YOUNG FIT PATIENTS

Objective: The role of endoscopic sphincterotomy in young fit patients cannot be established until the early complication rate and long-term effects of sphincter ablation are determined, the former being appare ntly unrelated to age and medical problems. We evaluated the early com plication rate and incidence of long-term biliary symptoms in patients under 55 years of age. Design and methods: Follow-up was performed by reviewing case notes. Patients and their general practitioners were a sked to complete a standardized questionnaire. Results: Of the 394 pat ients who underwent successful endoscopic sphincterotomy from 1980 to 1992, 45 (11%) were aged 55 years or under (mean 44 years, range 22-55 years). The indications for endoscopic sphincterotomy comprised stone s in 26 (62%) and papillary stenosis in 16 (38%) patients. None of the patients suffered from serious medical conditions. Two patients haemo rrhaged (associated with a faulty diathermy source) and two others had impacted baskets. The early complication rate was 9.5% and surgery wa s required in 7.1%; none of the patients died. Data from 30 of these p atients were obtained with a mean follow-up of 8 years (range 10 month s to 12 years). Three patients (10%) had further biliary problems: one with a stricture due to chronic pancreatitis had had a pancreatic sph incterotomy 9 years previously, but had not suffered any problems unti l 1992, one had an unplanned repeat endoscopic sphincterotomy 6 months later because of restenosis, and one had possible cholangitis. Four p atients (13%) had recurrent abdominal pain of uncertain cause. The rem aining patients did not have any problems relating to the biliary trac t. Conclusions: In young fit patients, endoscopic sphincterotomy may b e a relatively safe procedure and medium- to long-term results may be comparable with those of surgical procedures. Equipment failure is a p otential source of early complications.