The history of the development and technique of
endoscopic sphincterotomy are discussed. This includes a review of 796 successful
sphincterotomies out of 838 attempts. The indications for
sphincterotomy were
choledocholithiasis in 632 patients,
stenosis of the papilla of Vater in 136, periampullary
tumor in 24, and stones in the main pancreatic duct in 4 patients. Of 632 patients with
choledocholithiasis, 234 passed the stone spontaneously, and 358 has the stone extracted. Residual stones remained in 40 patients. Complications, such as
bleeding, retroperitoneal perforation,
pancreatitis,
cholangitis, and impaction of the Dormia basket, were noted. This indicates a morbidity of 6.9 percent. Fifteen patients required
laparotomy. The overall mortality was 1.13 percent. Endoscopic
laparotomy. The overall mortality was 1.13 percent.
Endoscopic sphincterotomy is a relatively safe and effective method for treatment of
extrahepatic cholestasis. The complication rate for patients at high risk is significantly lower than for patients undergoing conventional transabdominal operations.