Effect Of Endoscopic Sphincterotomy Research Articles

Effect of endoscopic sphincterotomy and endoscopic papillary balloon dilation endoscopic retrograde cholangiopancreatographies on the sphincter of Oddi.

Endoscopic retrograde cholangiopancreatography (ERCP), with its clinical ad-vantages of less trauma and faster recovery, has become the primary treatment for choledocholithiasis. To investigate the effects of different ERCP procedures on the sphincter of Oddi. The clinical data of 91 patients who underwent ERCP at Yixing Hospital of Traditional Chinese Medicine between February 2018 and February 2021 were analyzed retrospectively. The patients were divided into endoscopic sphincterotomy (EST, n = 24) and endoscopic papillary balloon dilation (EPBD, n = 67) groups. The duration of operation, pancreatic development, pancreatic sphincterotomy, intubation difficulties, stone recurrence, and incidence of reflux cholangitis and cholecystitis were statistically analyzed in patients with a history of choledocholithiasis, pancreatitis, and Oddi sphincter dysfunction in the EST and EPBD groups. Differences in hypertension, diabetes, increased bilirubin, small diameter of the common bile duct, or ampullary diverticulum between the two groups were not significant. Statistically significant differences were observed between the two groups concerning sex and age (< 60 years). Patients with a history of choledocholithiasis, pancreatitis, and Oddi sphincter dysfunction were higher in the EST group than in the EPBD group. The number of cases of pancreatic development, pancreatic duct sphincterotomy, and difficult intubation were higher in the EST group than in the EPBD group. The number of Oddi's sphincter manometries, ERCP surgical outcomes, and guidewires entering the pancreatic duct several times in EST group were lower than those in the EPBD group. The numbers of stone recurrences, reflux cholangitis, and cholecystitis were higher in the EST group than in the EPBD group. In summary, common bile duct stones, pancreatitis history, and multiple guided wire introductions into the pancreatic duct are independent risk factors for EST and EPBD. Based on this evidence, this study can provide actionable insights for clinicians and researchers.

Sa1274 EFFECT OF ENDOSCOPIC TRANSPAPILLARY METALLIC STENT PLACEMENT WITH/ WITHOUT ENDOSCOPIC SPHINCTEROTOMY ON POST-ERCP PANCREATITIS IN PATIENTS WITH MALIGNANT BILIARY OBSTRUCTION

Effect of endoscopic sphincterotomy (ES) prior to metallic stent (MS) placement in patients with distal malignant biliary obstruction (MBO) to prevent post-ERCP pancreatitis (PEP) remains to be fully elucidated, because the safety of non-adding ES for the cases without main pancreatic obstruction is unclear. To evaluate the efficacy and safety of non-adding ES prior to MS placement in patients with distal MBO, including those without MPD obstruction. Between January 2006 and August 2017, 285 patients with distal MBO were treated with MS placement in our tertial referral center, of which 74 were excluded because of a former history of ES, and/or prior MS placement. Finally, 211 patients were retrospectively enrolled in this study. Sixty-nine patients underwent ES just before MS placement (ES group), whereas 142 underwent MS placement without ES (non-ES group). We evaluated (1) the patients’ characteristics, (2) the incidence of PEP within 2 days after the procedure, (3) the incidence of bleeding, cholangitis, cholecystitis, and perforation within 30 days after the procedure, and (4) the effect of ES/ non-ES on the time to MS dysfunction. (1) Sex (man): ES, 40; non-ES, 83 (p = 0.947). Age (median): ES, 71 (range, 11–89); non-ES, 67 (range, 43–90) (p = 0.659). The etiology of MBO (bile duct cancer/ gall bladder cancer/ lymph node metastasis/ pancreatic cancer/ ampullary cancer): ES, 12/4/12/41/0; non-ES, 14/3/12/107/6 (p = 0.018). MPD obstruction: ES, 43; non-ES, 117 (p = 0.019). (2) PEP occurred in 11 patients in the ES group and in 20 in the non-ES group (p = 0.721). Among the patients without MPD obstruction (26 in the ES group and 25 in the non-ES group), PEP occurred in 10 patients in the ES group and in five in the non-ES group (p = 0.148). (3) Bleeding was significantly higher in the ES group (three patients) than in the non-ES group (zero patient, p = 0.034). Further, the incidence of cholangitis (four vs. five patients, p = 0.13), cholecystitis (four vs. four patients, p = 0.497), and perforation (zero patient in both) in the ES and non-ES groups, respectively, was not significantly different. (4) The median follow-up periods in the ES and non-ES groups were 191 (range, 14–999) and 204 (range, 12–1846) days, respectively. MS dysfunction was observed in 15 and 30 patients in the ES and non-ES groups, respectively (p = 0.919). The median time to MS dysfunction in the ES and non-ES groups was 145 (range, 6–465) and 114 (range, 2–759) days, respectively (p = 0.803). The study concluded that performing ES prior to MS placement for distal MBO does not reduce the incidence of PEP, but elevates the risks of bleeding related to ES. Hence, routine ES should be avoided prior to MS placement for distal MBO.

Endoscopic Sphincterotomy for Gallbladder Muddy Stones or Sludge in Patients With Papillary Disease: A Retrospective Study.

The formation of gallbladder stones is associated with dysfunctional contraction and duodenal papilla diseases. However, endoscopic sphincterotomy can improve the contraction of the gallbladder and resolve duodenal papilla disease. The aim of the study was to assess the feasibility and effectiveness of endoscopic sphincterotomy in the treatment of muddy stones or sludge in the gallbladder during papillary disease. The clinical data of 53 patients with gallbladder muddy stones or sludge undergoing endoscopic sphincterotomy were retrospectively analyzed. A total of 53 patients received successful endoscopic sphincterotomy with no serious complications. Sphincterotomy did not significantly lower resting gallbladder volume from 63.2±10.8 to 50.1±5.9 mL (P>0.05), but significantly increased gallbladder ejection fraction from 0.41±0.13 to 0.63±0.16 (P<0.01), as measured by the lipoid food test. The static liver and gallbladder imaging examination also showed an increase in gallbladder ejection fraction from 0.45±0.08 to 0.68±0.11 (P<0.01). In addition, the choledochus pressure reduced from 21.9±4.0 to 15.6±2.5 mm Hg, and the gallbladder muddy stones or sludge disappeared after endoscopic sphincterotomy. At the end of the follow-up period, there was no relapse of sludge or muddy stones in the gallbladder. The formation of gallbladder muddy stones or sludge is associated with papilla disease. Endoscopic sphincterotomy can resolve papilla disease, decrease gallbladder bile stasis, improve gallbladder evacuation, and prevent the formation of gallbladder stones.

Clinical effects of endoscopic sphincterotomy and papillary balloon dilation for treatment of obstructive jaundice

Clinical effects of endoscopic sphincterotomy and papillary balloon dilation for treatment of obstructive jaundice

Effect of endoscopic sphincterotomy on function of sphincter of Oddi and long-term complications

Objective To investigate the effect of EST on function of sphincter of Oddi and on the long-term complications. Methods A total of 68 patients with common bile duct stones were recruited from January 2009 to January 2013 in The First People＇s Hospital of Hangzhou. All patients were under follow-up to observe the incidence of late complications after EST. Oddi sphincter manometry and bile bacterial culture were performed before EST and one year later. Results With the 13-36 months follow-up,the incidence of late complications was 16.9% （11/65）. The peak pressure and frequency of contraction of Oddi sphincter after EST were significantly lower than those before EST, but there were no significant differences between patients with complication and without （ P 〉 0. 05 ）. After EST, positive rate of biliary bacteria in patients with complications was much higher than that in patients without complications [70% （7/10）vs. 31.7% （13/41）, P = 0. 026], although there were no significant differences between them before EST [54. 5% （6/11 ） vs. 46. 3% （25/54） , P = 0. 618 ）. Logistic regression analysis showed that cholecystolithiasis, bile duct diameter （ 〉 1.5 cm）, number of stone （ 〉 3 ）, maximun diameter of stone （ 〉 20 mm）, large EST were independent risk factors for late complications of EST. Conclusion Importance should be attached to the late complications of EST with Oddi sphincter function declination, and biliary enteric reflux being the basic factor in late compilations after EST, which are also influenced by many risk factors. Key words: Sphincterotomy, endoscopic ; Sphincter of Oddi ; Manometry; Late complications

The effect of endoscopic sphincterotomy on the motility of the gallbladder and sphincter of Oddi in patients with acalculous biliary pain syndrome

Sphincter of Oddi dysfunction usually occurs after cholecystectomy, but it can sometimes be detected in patients with intact gallbladder too. The diagnostic value of the non-invasive functional tests is not established in this group of patients and the effects of sphincterotomy on transpapillary bile outflow and gallbladder motility are unknown. The aim of this study was to determine the effect of endoscopic sphincterotomy on the gallbladder ejection fraction, transpapillary bile outflow and the clinical symptoms of patients with acalculous biliary pain syndrome. 36 patients with acalculous biliary pain syndrome underwent quantitative hepatobiliary scintigraphy, and all of them had decreased cholecytokinin-induced gallbladder ejection fraction. The endoscopic manometry of the sphincter of Oddi showed abnormal sphincter function in 26 patients who were enrolled the study. Before and after endoscopic sphincterotomy all patients had ultrasonographic measurement of cholecystokinin-induced gallbladder ejection fraction with and without nitroglycerin pretreatment and scintigraphy was repeated as well. The effects of sphincterotomy on gallbladder ejection fraction and transpapillary biliary outflow were evaluated. In addition, changes in biliary pain score with a previously validated questionnaire were also determined. All 26 patients had decreased gallbladder ejection fraction before sphincterotomy measured with scintigraphy (19+18%) and ultrasound (16+9.7%), which was improved after nitroglycerin pretreatment (48.2+17%; p<0.005). Detected with both methods, the ejection fraction was in the normal range after sphincterotomy (52+37% and 40.8+16.5%), but nitroglycerin pretreatment failed to produce further improvement (48.67+22.2%, NS). Based on scintigraphic examination sphincterotomy significantly improved transpapillary biliary outflow (common bile duct half time 63±33 min vs. 37±17 min; p<0.05). According to results obtained from questionneries, 22 of the 26 patients gave an account of significant symptom improvement after sphincterotomy. Endoscopic sphincterotomy improves cholecystokinin-induced gallbladder ejection fraction, transpapillary biliary outflow as well as biliary symptoms in patients with acalculous biliary pain syndrome and sphincter of Oddi dysfunction. Cholecystokinin-induced gallbladder ejection fraction with nitroglycerin pretreatment, measured with ultrasonography can be useful to select a subgroup of patients who can benefit from sphincterotomy.

The effect of endoscopic sphincterotomy in patients with acalculous biliary type pain and impaired caerulein-induced gallbladder ejection fraction – preliminary results

The effect of endoscopic sphincterotomy in patients with acalculous biliary type pain and impaired caerulein-induced gallbladder ejection fraction – preliminary results

Effect of endoscopic sphincterotomy and interval cholecystectomy on late outcome after gallstone pancreatitis.

Endoscopic sphincterotomy alone, or followed by cholecystectomy, are options in patients with gallstone pancreatitis. Ninety-six patients of median age 74 (range 30-93) years with gallstone pancreatitis had endoscopic retrograde cholangiography and were followed for a median of 84 (range 33-168) months. Forty-eight of 49 patients with, and nine of 47 without, common bile duct (CBD) stones had urgent endoscopic sphincterotomy. One patient with, and six without, CBD stones had delayed endoscopic sphincterotomy a median of 35 (range 12-111) days after acute pancreatitis. Thus, 64 patients had endoscopic sphincterotomy (group 1) and 32 did not (group 2). Fifteen and 16 patients in each group respectively had interval cholecystectomy after a median of 3 months and 1 month. Patients in groups 1 and 2 had similar rates of interval cholecystectomy (15 of 64 versus 16 of 32 patients respectively) or required cholecystectomy (15 of 49 versus five of 16 patients), recurrent CBD calculi (three of 64 versus three of 32 patients) or total length of hospitalization after interval cholecystectomy (median 15.5 and 15 days) or required (median 22 and 24 days) cholecystectomy. The overall incidence of recurrent pancreatitis was one of 64 patients in group 1 and five of 32 in group 2 (P = 0.02), but after interval cholecystectomy the recurrence rate of biliopancreatic symptoms was similar (one of 15 patients versus three of 16 patients respectively). Endoscopic sphincterotomy, but not interval cholecystectomy, reduced the overall incidence of recurrent pancreatitis, but not of late biliary complications. Some 31 per cent of the patients required cholecystectomy, suggesting that routine cholecystectomy should be considered in fit patients following acute pancreatitis.

The effect of endoscopic sphincterotomy on acute and chronic complications of biliary endoprostheses

Background: Endoscopically placed biliary stents have become routine therapy for bile duct obstruction and bile leaks. Controversy exists regarding the use of biliary sphincterotomy to facilitate placement of 10F plastic stents. Methods: We retrospectively studied the effect of sphincterotomy on acute and chronic complications of 10F stent therapy. Data for acute complications, 30-day mortality and stent migration were obtained for 130 patients undergoing placement of a single 10F plastic biliary stent. For 109 patients in whom prolonged stent therapy was undertaken, the occurence of and time to stent dysfunction were also analyzed. Sphincterotomy was performed in 48 cases (36.9%) based on physician preference. Results: There were no failures in stent placement. The incidence of acute complications was higher in patients undergoing sphincterotomy (8.3% vs. 1.2%, p = 0.04). Stent migration was more common in the no sphincterotomy group versus the sphincterotomy group (8.5% vs. 0, p = 0.03). Conclusions: Sphincterotomy is not necessary for placement of 10F plastic stents and increases acute procedural morbidity. Interestingly, a higher incidence of stent migration was seen in patients who did not undergo biliary sphincterotomy. (Gastrointest Endosc 1999;49:716-9.)

Influence of bile duct stones on patient features and effect of endoscopic sphincterotomy on early outcome of edematous gallstone pancreatitis.

The objective of this study was to study the influence on patients' features and the effect on early outcome of the presence of bile duct stones and endoscopic sphincterotomy (EST), respectively, in the presence of edematous gallstone pancreatitis (GSP). It was a retrospective review of a patient series from 1981 through 1992 at a university teaching hospital. Altogether 96 patients aged 42 to 93 years (median 74 years) with edematous GSP were investigated by endoscopic retrograde cholangiography (ERC) in our department, 75 of whom underwent ERC at first admission. A total of 49 patients (group 1) had common bile duct (CBD) stones, and in 47 (group 2) no CBD stones were found. All patients in group 1 and 15 in group 2 underwent EST; 57 of the 75 patients had EST at first admission. The main outcome measures were pancreas-related complications and the length of the hospital stay. The early major complication and stone clearance rates of the EST procedure were 3.2% and 96%, respectively. Duration of symptoms prior to ERC was similar in groups 1 and 2 (median 5 and 8 days, respectively). Serum amylase activity was higher in group 2 patients than in group 1 patients [21-258 (median 75) microkat/L vs. 10-328 (median 48) microkat/L (p = 0.01)], but the length of hospital stay was similar: [4-39 (median 11) days vs. 4-19 (median 9) days (p = 0.05)]. Cholangitis at acute admission was more common in group 1 than in group 2 patients (31% vs. 7%; p = 0. 02), whereas a history of pancreatitis was noted more often in group 2 patients (49% vs. 8%; p< 0.001). ERC was done 1 to 18 days (median 2 days) and 1-16 days (median 5 days) (p = 0.02) after admission in groups 1 and 2 respectively, because of the more frequent cholangitis symptoms in group 1. It was concluded that the history and features at admission differed between patients with and without CBD stones at ERC done during an attack of GSP. Early EST had no influence on outcome or hospitalization. This study does not support routine EST in conjunction with mild GSP.

Effectiveness of endoscopic sphincterotomy in complicated hepatic hydatid disease

Background:The aim of this study was to evaluate the results of endoscopic sphincterotomy in patients with hepatic hydatid cysts that have ruptured into the biliary tract. Methods:Over a 10-year period, 25 patients (11 men, 14 women, mean age 60 years) underwent treatment; 13 with no prior surgery were treated for biliary obstruction. Postoperative treatment was undertaken in 12 cases because of persistent drainage (8), duct obstruction (3), and postoperative pancreatitis (1). Results:In patients who had not undergone previous surgery, cholangiographic findings were hydatid vesicles in the biliary tract (6), dilation of the biliary tract (3), biliary fistula (2), distal stenosis (1), and purulent bile content after sphincterotomy (1). In all of these cases, sphincterotomy resolved duct obstruction with no complications. All patients with persistent postoperative drainage had a fistula tract between the biliary duct and the cavity, which was resolved by endoscopic treatment in all 8. The 3 patients with postoperative biliary obstruction had hydatid vesicles in the biliary tract, one with a long stenosis resembling sclerosing cholangitis, whereas the patient with postoperative pancreatitis had a distal stenosis. Satisfactory results were obtained with endoscopic sphincterotomy, although 1 patient required a biliary prosthesis. Conclusion:Endoscopic sphincterotomy resolves biliary obstruction and postoperative fistulae in most patients with hepatic hydatid cysts that have ruptured into the biliary tract. In some cases, a biliary prosthesis may be required. (Gastrointest Endosc 1998;48:593-7.)

Gall bladder motility after endoscopic sphincterotomy

Editor,—We read with interest the article by Sugiyama and Atomi ( Gut 1996; 39 :856–9) on the effect of endoscopic sphincterotomy (ES) on gall bladder motility. These authors have proved conclusively that ES causes a significant improvement in gall bladder motility in humans. We have assessed gall bladder motility in patients who underwent ES for common bile duct (CBD) stones and compared these with patients with gall bladder calculi but without CBD stones. We found significantly lower fasting and residual gall bladder volumes in the patients who had undergone ES, indicating reduced filling after ES.1 However, the ejection fraction and the rate constant of gall bladder emptying in these patients was increased significantly, suggesting increased gall bladder emptying. In another study2 we found a significant decrease in fasting volume (mean (SD) 18.3 (8.5) v 13.9 (7.3) ml), residual volume (12.0 (8.0) v 4.4 (3.2) ml) and an increase in the ejection fraction (54.3 (9.8) v 83.5 (5.4)) after ES, suggesting decreased stasis and increased gall bladder emptying. In Sugiyama and Atomi’s this study, all patients in whom gall bladder motility was assessed before ES had CBD stones; all stones were extracted before … Dr Sugiyama.

Effect of endoscopic sphincterotomy on gall bladder bile lithogenicity and motility

Background—Endoscopic sphincterotomy has been shown to inhibit stone formation in the gall bladder of experimental animals.Aims—To investigate the alterations in bile composition and gall bladder motility after endoscopic sphincterotomy.Patients—A study...

Gallbladder motility and lithogenicity of bile in patients with choledocholithiasis after endoscopic sphincterotomy

Background/Aims: Ablation of the sphincter of Oddi has been shown to inhibit gallstone formation in the prairie dog model, probably by allevaiting gallbladder bile stasis. The effect of endoscopic sphincterotomy (ES) on gallbladder emptying and lithogenicity of bile has not been studied adequately in humans. We, therefore, studied the changes in gallbladder emptying and lithogenicity of bile following ES in patients with choledocholithiasis and gallbladder in situ. Methods: Thirteen patients with choledocholithiasis with intact gallbladder underwent ES and common bile duct clearance. Eight patients had concomitant gallstones. Gallbladder emptying was studied by real time ultrasonography after stimulation by ceruletid infusion. Fasting gallbladder bile was collected during endoscopic retrograde cholangiography by placing a 7F or 8F catheter in the common bile duct and after ceruletid stimulation of gallbladder for bile microscopy and cholesterol nucleation time determination. Gallbladder emptying, nucleation time and bile microscopy were performed before ES and again between 4 and 8 weeks after ES after cholangiographic confirmation of clearance of common bile duct stones. Results: Fasting and residual gallbladder volumes decreased and ejection fraction increased significantly following ES, suggesting decreased stasis and improved emptying of gallbladder. Nucleation time was prolonged and cholesterol crystal index in bile decreased after ES, suggesting decreased lithogenicity. The decrease in gallbladder volumes and increase in ejection fraction after ES were observed in both groups of patients, with or without concomitant gallstones. Conclusions: ES decreases the stasis of gallbladder bile, improves gallbladder emptying and decreases the lithogenicity of bile in patients with gallstone disease as reflected by prolongation in nucleation time. ES may find a role as an adjunct to oral bile acid therapy and extracorporeal shock wave lithotripsy in addition to a prophylactic role of preventing gallstone formation in high risk groups.

Sphincter of oddi dysfunction (SOD) in patients with intact gallbladder: Therapeutic effect of endoscopic sphincterotomy (ES)

Sphincter of oddi dysfunction (SOD) in patients with intact gallbladder: Therapeutic effect of endoscopic sphincterotomy (ES)

Sphincter of oddi dysfunction (SOD) in patients with idiopathic recurrent pancreatitis (IRP) and intact gallbladders: Long term therapeutic effect of endoscopic sphincterotomy (ES)

Sphincter of oddi dysfunction (SOD) in patients with idiopathic recurrent pancreatitis (IRP) and intact gallbladders: Long term therapeutic effect of endoscopic sphincterotomy (ES)

Effect of endoscopic sphincterotomy on gallbladder motility.

In experimental animals, sphincterotomy facilitates passage of solids from the gallbladder and inhibits gallstone formation apparently by improvement in gallbladder emptying. In humans, however, gallbladder emptying has not been studied following endoscopic sphincterotomy (ES) in patients with gallstones. We therefore prospectively studied resting and cerulin-stimulated gallbladder volumes by real time ultrasonography in 15 patients of choledocholithiasis with gallbladder in situ (eight with and seven without gallbladder calculi) before and after (after bile duct clearance) ES. ES significantly lowered resting gallbladder volume (21.2 +/- 10.6 vs 11.1 +/- 5.0; P < 0.0001) and cerulin-stimulated residual gallbladder volume (10.8 +/- 5.6 vs 4.4 +/- 2.1; P < 0.0001). ES also significantly increased the gallbladder ejection fraction (47.3 +/- 12.1% vs 58.8 +/- 11.1%; P < 0.0001). The rate constant for gallbladder emptying after cerulin infusion also increased significantly after ES (-0.022/min vs -0.031/ min; P < 0.0001). Significant improvement in gallbladder motility was observed in both groups of patients with and without gallbladder calculi. ES significantly improves gallbladder motility in humans.

Divergent effects of endoscopic sphincterotomy on the long-term outcome of hepatolithiasis

Divergent effects of endoscopic sphincterotomy on the long-term outcome of hepatolithiasis

Effect of endoscopic sphincterotomy on chenodeoxycholic acid pool size and turnover rate in cholecystectomized patients

Effect of endoscopic sphincterotomy on chenodeoxycholic acid pool size and turnover rate in cholecystectomized patients

Effect of endoscopic sphincterotomy on bile acid pool size and bile lipid composition in man.

The effect of endoscopic sphincterotomy on bile acid pool size and lipid composition was studied in 3 patients with an intact gallbladder and in 7 patients who had previous cholecystectomy. Measurements were made at two time intervals after endoscopic sphincterotomy, early (3-9 days) and late (6-9 months). Patients with an intact gallbladder showed a marked reduction in their total bile acid pool during follow-up examinations (95.3 +/- SD 14.0 vs. 18.6 +/- 8.1 mumol/kg), whereas in the cholecystectomized patients the pool size showed no significant change (29.4 +/- 13.4 vs. 26.6 +/- 11.4 mumol/kg). The reduction in bile acid pool size caused by sphincterotomy in patients with an intact gallbladder did not increase the degree of cholesterol saturation in hepatic bile.