Endoscopic Papillotomy for Recurrent Common Bile Duct Stones and Papillary Stenosis

Mazzeo, Robert J.; Jordan, F. T. W.; Strasius, Stanley R.

doi:10.1001/archsurg.1983.01390060015003

Cited by 8 publications

(3 citation statements)

References 9 publications

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“…The operative mortality for all patients is not statistically different from those reported in large institutional studies from the United States and Europe. This mortality rate is low (0.6%) after cholecystectomy, increases by a factor of 4 when common duct exploration is added, and raises the question as to whether duct stones should be treated primarily by transduodenal sphincterotomy as recommended by many United States and European clinicians [14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

The current status of biliary tract surgery: An international study of 1072 consecutive patients

DenBesten

Berci

1986

World j. surg.

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An international study to determine the practice patterns and outcome of operations for stone‐related biliary tract disorders was commissioned by the International Biliary Association in 1981. Twenty‐one institutions generated 69,700 data bits from 1,072 consecutive patients over an 18‐month period. These data were analyzed for approach to diagnosis, conduct of operation, and outcome. Of the 1,072 operations (412 United States, 660 international), 986 (92%) were primary and 86 (8%) were secondary or repeat procedures. Although elective cholecystectomy was preceded by 2 or more diagnostic tests in 25% of patients, institutional patterns ranged from a single test in 60% of patients to 94% of patients having more than 3 preoperative diagnostic tests. Elective cholecystectomy included operative cholangiography in 83% of patients and choledochotomies in 17% (182 of 1,072). The incidence of negative duct exploration and retained stones was 18.5% and 4.5%, respectively. Choledochoscopy was done before duct exploration in 25% (30.4%‐U.S.A.; 19.5%‐international) and prior to T‐tube insertion in 38% (29%‐U.S.A.; 43%‐international). Repeat operations for choledocholithiasis included a drainage procedure in 72% of American and 46% of European patients. Complications after primary procedures were 17% in the United States (12.4% biliary, 4.4% nonbiliary) and 35% (25% biliary, 9.1% nonbiliary) in the international series. Complications after secondary procedures were 48% (40% biliary, 8% nonbiliary). The mortality rate for all patients was 1.6% for primary procedures (0.6% for cholecystectomy alone) and 2.3% for secondary procedures. These data indicate that: (a) duplication of diagnostic procedures is frequent and characteristic of certain institutions; (b) cholangiography decreases the incidence of negative choledochotomy, and choledochoscopy reduces the incidence of retained stones; and (c) diagnosis, operative management, and outcome vary greatly among institutions.

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Section: Discussionmentioning

confidence: 99%

The current status of biliary tract surgery: An international study of 1072 consecutive patients

DenBesten

Berci

1986

World j. surg.

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“…In Europe and the United States the rate of death following EST was reported as 1.2 to 1.4% 12 , 39 , 40) . This rate is lower than the mortality rate of 2.1% 41) following a reoperation of the common bile duct. Therefore, EST is considered to be a relatively safe procedure in high-risk surgical patients with common bile duct stones.…”

Section: Discussionmentioning

confidence: 56%

Problems in Endoscopic Sphincteropapillotomy

Yang

Myeong

Yeo

et al. 1987

Korean J Intern Med

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Since 1976, endoscopic retrograde cholangiopancreatography(ERCP) has been done in 2,185 cases at Kwangju Christian Hospital in Kwangju, Korea, Between November 1981 and September 1986, endoscopic sphincteropapillotomy(EST) was performed on 194 patients. The results are as follows: 1) Common bile duct stones were found in 171 patients, ascaris in the common bile ducts of 12 patients, ascaris and stones in the common bile duct of 1 patient, clonorchis in the bile ducts of 4 patients, fibrotic stenosis of the periampullary choledochoduodenal fistula in 1 patient, stenosis of the common bile duct in 1 patient and stones in the pancreatic ducts of 4 patients.2) In five cases the stones were extracted under direct vision, in 61 cases the stones were passed in the stool, while in 66 cases stone elimination was confirmed by repeated ERCP or T-tube cholangiography. In 46 cases the stones were not removed, but symptoms and laboratory findings showed marked improvement.3) Complications following EST included 5 cases of bleeding, 1 case of acute pancreatitis with a pancreatic pseudocyst, one death due to sepsis following cholangitis, 5 cases of recurrent cholangitis and 2 cases of recurrent pancreatitis.4) The conditions under which EST became difficult or did not succeed included periampullary diverticula, fibrotic stenosis of ampulla of Vater and stones in the intrahepatic ducts or a gallbladder.5) With improved EST technical maneuverability, we could prevent bleeding and acute pancreatitis with a pancreatic pseudocyst and perform EST successfully in cases with periampullary diverticula.

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“…If deposits are present, Vater’s sphincter is incised with an electric knife and all deposits can be removed using balloon catheters – baskets (spiral, flowery, Dormia) [16]. The effectiveness of this procedure in clinical trials is 80-99% and clearly depends on the operator’s experience [17,18]. The complications of endoscopic papillotomy include pancreatitis, cholangitis, sepsis, perforation, bleeding, and impaction of the basket; according to the literature data, their incidence is 8% [19,20].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract

et al. 2018

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PurposeIn the present study, the effectiveness and safety of minimally invasive percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract were assessed.Material and methodsBetween 2000 and 2015, 12 patients (seven women and five men, mean age 78 ± 8 years) after open cholecystectomy with common bile duct exploration and T-tube drainage underwent percutaneous extraction of residual gallstones through the T-tube tract.ResultsThe intervention was successful in 92% (11/12). In seven patients complete extraction of the retained gallstones was achieved, and in four cases partial extraction combined with passage of small residual fragments to the duodenum was obtained. In one case the extraction attempt was ineffective. Mild haemobilia was observed in two patients. No mortality or major complications were observed.ConclusionsOur findings are consistent with literature data and confirm that percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract is an effective and safe treatment method. Although the presented technique is not a novel approach, it can be beneficial in patients unsuitable for open surgery or laparoscopic intervention when ERCP attempt occurs ineffective or there exist contraindications to ERCP.

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Endoscopic Papillotomy for Recurrent Common Bile Duct Stones and Papillary Stenosis

Cited by 8 publications

References 9 publications

The current status of biliary tract surgery: An international study of 1072 consecutive patients

The current status of biliary tract surgery: An international study of 1072 consecutive patients

Problems in Endoscopic Sphincteropapillotomy

Percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract

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