[Indications for endoscopic papillotomy].

Abstract

Endoscopic sphincterotomy (ES) with stone removal is indicated in the post-cholecystectomy patient with retained or recurrent stones and for the very high risk surgical patient. ES has a role in the treatment of severe acute biliary pancreatitis (ABP), but not in mild ABP. Acute suppurative cholangitis refractory to antibiotics can be successfully treated by ES with stone removal or nasobiliary drainage not only in high risk surgical patients. However, concomitant occurrence of abscesses in the liver and other locations, and of gallbladder empyema, calls for an interdisciplinary approach (surgical, endoscopic and radiological). Controlled studies in this field are needed. The role of ES and stone removal in cholelithiasis of patients with gallbladders in situ and low surgical risk remains controversial, as does the treatment of patients with sump syndrome after choledochoduodenostomy, with biliary-cutaneous or biliary-enteric fistulas and benign strictures, which must be evaluated by accurate comparative studies. Whereas ES has its place in the treatment of Oddi sphincter dysfunction with elevated sphincter pressures, and for the introduction of large bore endoprostheses for palliative treatment of malignant biliary stenoses, ES is still experimental in the treatment of pancreatolithiasis, pancreatic duct stenoses, endoscopic gallbladder stone removal and transpapillary retrograde cholangioscopy.