STENT-GUIDED SPHINCTEROTOMY

Performing sphincterotomy when either Billroth II gastrectomy or compl icated periampullary diverticula are present may increase the risk of complications. In addition a sphincterotomy on the main pancreatic sph incter or the papilla of Santorini presents complicated problems. Sten t-guided sphincterotomy has been utilized in 229 patients presenting t o our institution from 1983 through 1992. They were performed in 67 pa tients who had undergone Billroth II gastrectomy, 23 with periampullar y diverticula, 57 with pancreas divisum, and 82 with a history of recu rrent pancreatitis. To prevent ductal injury or perforation, a stent i s first inserted into the biliary or pancreatic duct to guide the sphi ncterotomy incision. The sphincterotomy is performed using electrocaut ery current delivered through a ''needle knife'' sphincterotome. Pancr eatitis occurred in 19 patients (8.3%). It was mild in 17 and moderate in two patients. One patient experienced severe hemorrhage requiring surgery. No mortality or perforations occurred. The stent-guided needl e knife sphincterotomy approach is an effective technique. It has a lo w complication rate even in these difficult anatomic conditions. It as sures that the incision precisely follows the duct when performing pan creatic sphincterotomy.