Endoscopic Sphincterotomy Using Various Techniques in the Management of Biliary Tract Diseases-Experience in 99 Cases

Abstract

Endoscopic sphincterotomy (EST) has gained popularity in the management of biliary tract diseases, and the advancement of EST techniques (such as precut, needle knife and wire-guided sphincterotomy) can improve the success rate of difficult cannulations. A total of 99 patients received endoscopic sphincterotomy (EST) 100 times from Sept. 1992 to May 1995. Various methods (including standard EST, wire-guided EST, precut papillotomy and needle knife papillotomy & fistulotomy) were used. Indications for sphincterotomy included: common bile duct (CBD) stones in 90 patients, biliary stenting for malignant tumor in 4 patients, bile leakage in 2 patients, biopsy of hilar tumor in one patient, diagnostic cholangiography in one patient and insertion of nasobiliary catheter in one patient. EST was successful with standard method in 63% of cases, wire-guided EST in 24%, precut papillotomy in 4%, and needle knife papillotomy in 5%. EST failed in 4%. In 90 patients with CBD stones, EST succeeded in 87 patients (96.7%) and bile ducts were cleared in 70 patients (80%). EST alone stopped the bile leakage in 2 patients. The 4 patients with biliary malignancy received biliary stenting by the ”combined percutaneous and endoscopic method”. The complications were 8% in our series (bleeding in 4 patients, cholangitis in two patients, pancreatitis in one patient and acute cholecystitis in one patient). In conclusion, EST is the most useful tool in the management of biliary diseases, and special techniques in EST (such as precut, needle knife and wire-guided sphincterotomy) can increase the success rate of the biliary approach.