[Quo vadis endoscopic sphincterotomy?].

Abstract

The results of a study from 25 centers (= Series I: 1974-1980) covering 9041 endoscopic sphincterotomies (EST) were compared with those of a second study from 20 centers (= Series II: 1981-1986) covering 10177 cases. A change was seen in the indications during the past 5 years: While choledocholithiasis after cholecystectomy remained the main indication, EST is performed with increasing frequency in patients with common bile duct stones having their gallbladder in situ as a definitive method with low complications (only 0.61% emergency cholecystectomies): Circumscript papillary stenosis became quite a rare indication. The success rate of EST because of choledocholithiasis was not improved in spite of new techniques (stone-free common bile ducts in I: 84.06%, in II: 83.97%). The complication rate decreased from 7.55% to 5.04%. Types of complications did not change. Only perforations decreased, the rates of bleeding, cholangitis and pancreatitis remained the same. The mortality diminished from 1.12% to 0.60% (the figures remained twice as high in papillary stenosis than in choledocholithiasis). There was no change in the results of EST during the past 5 years. Follow-up studies using radiological methods show worse results (recurrent stones in II: 21.2%, in I: 5.8%, stenosis of EST in II: 6.1%, in I: 3.1%): Late results of EST because of papillary stenosis are still worse compared to those of choledocholithiasis. Therefore, in spite of increasing experience and introduction of new techniques the method became safer, but the therapeutic results did not appreciably improve.