Endoscopic sphincterotomy

N9. Nowak, A., Nowakowska-Dulawa, E., Marek, T. A., and Rybicka, J., Final results of the prospective randomized, controlled study on endoscopic sphincterotomy versus conventional management in acute biliary pancreatitis. Gastroenterology 108, A380 (1995). 

Gogel, H.K., Runyon, B.A., Volpicelli, N.A., Palmer, R.C Acute suppurative obstructive cholangitis due to stones treatment by urgent endoscopic sphincterotomy. Gastrointest. Endosc. 1987 33 210—213... 

Margulies C, Siqueira ES, Silverman WB et al (1999) The effect of endoscopic sphincterotomy on acute and chronic complications of biliary endoprostheses. Gastrointest Endosc 49 716-719... 

If an endoscope is used, a sphincterotome (a device used hy endoscopists for performing endoscopic sphincterotomy) can he very helpful. The sphincterotome has a bow wire which deflects the tip of the device. This can he used with various levels of flexion to try and steer the tip of the catheter into the lumen of the obstruction. Once the guidewire has passed through the stricture, the sphincterotome is straightened, passed over the wire and then a standard wire placed for stenting. 

Iatrogenic duodenal injuries are rare complications of endoscopy. Perforation rarely occurs during routine endoscopy but may result from incorrect mucosal biopsy. Duodenal perforation is much more likely to follow endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy. The latter procedure involves a diathermy cut through the muscular sphincter of Oddi in a cranial direction. The line of the cut should ideally run in a twelve o clock direction to the papilla, and retroperitoneal perforation is much more likely to occur if there is significant deviation from this approach. The reported incidence is 0.5%-2% (Zissin et al. 2000). On CT,... 

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