Digestive Diseases and Sciences

, Volume 40, Issue 12, pp 2550–2554 | Cite as

Papillary dilation vs sphincterotomy in endoscopic removal of bile duct stones a randomized trial with manometric function

  • Atsushi Minami
  • Toshiaki Nakatsu
  • Naohito Uchida
  • Shuko Hirabayashi
  • Hiroki Fukuma
  • Syed Ahmed Morshed
  • Mikio Nishioka
Pancreatic and Biliary Disorders

Abstract

To circumvent the long-term effects of papillary ablation for extracting common bile duct stones (<12 mm in diameter) in endoscopic sphincterotomy (EST), endoscopic papillary dilation (EPD) was attempted in 20 patients. To evaluate papillary function before and after the procedures, manometry of the sphincter of Oddi was carried out in 13 with EPD and 10 of 20 patients with EST. Extraction of all stones was successful (100%) in both groups at an equal rate. Repeated numbers of procedures were common in both groups. However, the mean duration of the procedure was high in EPD compared to EST (63 min vs 42 min,P<NS). Adjunctive therapies like mechanical lithotripsy (ML), nasobiliary drainage, and choledochoscopy were included in EPD, while EST required a basket catheter and ML. There was no significant difference on manometry before and after the procedures (P=NS), although papillary function was found to have decreased after the EPD. In contrast, all patients in the EST group lost papillary function after the procedure. Thirty-day morbidity and mortality rate were absent in both groups. Immediate and 2.5-year follow up complications were uncommon in both groups. As a simple method, EPD may be an effective and safe alternative to EST in the management of patients with bile duct stones who require maintenance of papillary function.

Key Words

papillary dilation sphincterotomy manometry bile duct stone 

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References

  1. 1.
    Classen ML, Demling L: Endoskopishe, sphinkterotomie der papilla Vateri und steinextrktion aus dem ductus choledochus. Dtsch Med Wochenschr 99:496–497, 1974.Google Scholar
  2. 2.
    Classen M: Endoscopic papillotomy new indications, short and long term results. Clin Gastroenterol 15:457–469, 1986Google Scholar
  3. 3.
    Cotton PB: Endoscopic management of bile duct stones (apple and oranges). Gut 25:587–597, 1984Google Scholar
  4. 4.
    Miller BM, Kozarek RA, Ryan JA, Ball TJ, Traverso LW: Surgical versus endoscopic management of common bile duct stones. Ann Surg 207:135–141, 1988Google Scholar
  5. 5.
    Sherman S, Ruffolo TA, Hawes RH, Lehman GA: Complications of endoscopic sphincterotomy: A prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and non dilated bile ducts. Gastroenterology 101:1068–1075, 1991Google Scholar
  6. 6.
    Seifert E, Gail K, Weismuller J: Langzeitresulate nach endoskopischer sphincterotomie: Follow-up studie aus 25 Zentren in der Bundesrepublik. Dtsch Med Wochenschr 107:610–614, 1982Google Scholar
  7. 7.
    Reimann JR, Lux G, Forster P: Long-term results after endoscopic papillotomy. Endoscopy 15:165–168, 1983Google Scholar
  8. 8.
    Rosch W, Reimann, JR, Lux G, Linder HG: Long-term follow-up after endoscopic papillotomy. Endoscopy 13:152–153, 1981Google Scholar
  9. 9.
    Escourrou J, Cordova A, Lazorthes F, Frexinos J, Ribet A: Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without gallbladder “in situ”. Gut 25:598–602, 1984Google Scholar
  10. 10.
    Ikeda S, Tanaka M, Matsumoto S, Yoshimoto H, Itoh H: Endoscopic sphincterotomy: Long-term results in 408 patients with complete follow-up. Endoscopy 20:13–17, 1988Google Scholar
  11. 11.
    Jacobson O, Matzen P: Long-term follow-up of patients after endoscopic sphincterotomy for choledocholithiasis. Scand J Gastroenterol 22:903–906, 1987Google Scholar
  12. 12.
    Muhldorfer SM, Kekos G, Hahn EG, Ell C: Complications of therapeutic gastrointestinal endoscopy. Endoscopy 24:276–283, 1992Google Scholar
  13. 13.
    Staritz M, Ewe K, Meyer zum Bushenfelde K-H: Endoscopic papillary dilation (EPD) for the treatment of common bile duct stones and papillary stenosis. Endoscopy 15:197–198, 1983Google Scholar
  14. 14.
    Bader M, Greenen JE, Hogan WJ, Dodds WJ, Venu R, Johnson GK: Endoscopic balloon dilatation of the sphincter of Oddi in patients with suspected biliary dyskinesia: Results of a prospective randomized trial. Gastrointest Endosc 32:158, 1986 (abstract)Google Scholar
  15. 15.
    Blackstone MG: Balloon sphincteroplasty vs endoscopic papillotomy for bile duct stones. Lancet 342:1314–1315, 1993Google Scholar
  16. 16.
    May GR, Cotton PB, Simon EJ, Edmunds O: Removal of stones from the bile duct at ERCP without sphincterotomy. Gastrointest Endosc 39:749–754, 1993Google Scholar
  17. 17.
    Mathuna PM, White P, Clarke E, Lennon J, Crowe J: Endoscopic sphincteroplasty: A novel and safe alternative to papillotomy in the management of bile duct stones. Gut 35:127–129, 1994.Google Scholar
  18. 18.
    Guelrud M: Papillary stenosis. Endoscopy 20:193–202, 1988Google Scholar
  19. 19.
    McCune WS, Shorb PE, Moscovitz H: Endoscopic cannulation of the ampulla of Vater: A preliminary report: Ann Surg 167:752–756, 1968Google Scholar
  20. 20.
    Staritz M: Pharmacology of the Sphincter of Oddi. Endoscopy 20:171–174, 1988Google Scholar
  21. 21.
    Bar-Meir S, Geenen JE, Hogan WJ, Dodds WJ, Stewart ET, Arndorfer RC: Biliary and pancreatic duct pressures measured by ERCP manometry in patients with suspected papillary stenosis. Dig Dis Sci 24:209–213, 1979Google Scholar
  22. 22.
    Carr-Locke DL, Gregg JA: Endoscopic manometry of pancreatic and biliary sphincter zones in man: Basal results in healthy volunteers. Dig Dis Sci 26:7–15, 1981Google Scholar
  23. 23.
    Csendes A, Kuruse A, Funch-Jensen P, Oster MJ, Ornsholt J, Amdorup E: Pressure measurements in the biliary and pancreatic duct systems in controls and in patients with gallstones. previous cholecystectomy or common bile duct stones. Gastroenterology 77:1203–1210, 1979Google Scholar
  24. 24.
    Demling L, Seuberth K, Riemann JF: Clinical application of a new mechanical lithotripter for smashing common bile duct stones. Endoscopy 14:226–230, 1982Google Scholar
  25. 25.
    Cotton PB, Burney GJ, Mason RR: Transnasal bile duct catheterization after endoscopic sphincterotomy. Gut 20:285–287, 1979Google Scholar
  26. 26.
    Kozarek RA: Balloon dilation of the sphincter of Oddi. Endoscopy 20:201–210, 1988Google Scholar
  27. 27.
    Sherman S, Lehman GA: ERCP and endoscopic sphincterotomy induced pancreatitis. Pancreas 6:350–367, 1991Google Scholar
  28. 28.
    Glenn F, McSherry CK: Curr Probl Surg June: 1–38, 1975Google Scholar
  29. 29.
    Smithline A, Hawes R, Lehman G: Sphincter of Oddi manometry: Interobserver variability. Gastrointest Endosc 39:486–491, 1993Google Scholar
  30. 30.
    Toouli J, Geenen JE, Hogan WJ, Dodds WJ, Arndorfer RC: Sphincter of Oddi motor activity: A comparison between patients with common bile duct stones and controls. Gastroenterology 82:111–117, 1982Google Scholar
  31. 31.
    Reymond MA, Chapuis N, Vala D, Grillet MP, Merlinim M: Flexible choledochoscopy: Two years experience. Helv Chir Acta 60:81–85, 1993Google Scholar
  32. 32.
    Komiya O: Technical potential and limitations of cholangioscope. Endoscopy 21:338–340, 1989Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Atsushi Minami
    • 1
  • Toshiaki Nakatsu
    • 1
  • Naohito Uchida
    • 1
  • Shuko Hirabayashi
    • 1
  • Hiroki Fukuma
    • 1
  • Syed Ahmed Morshed
    • 1
  • Mikio Nishioka
    • 1
  1. 1.Third Department of Internal MedicineKagawa Medical SchoolKagawaJapan

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