Results of endoscopic papillotomy: A collective experience from nine endoscopic centers in West Germany

Abstract

This is a report of 1,403 patients who underwent endoscopic papillotomy (EPT) in 9 endoscopic centers in West Germany from 1973 up to April 1, 1977. The main indication for EPT was stones in the bile ducts causing obstructive jaundice. In 79.5% of the patients, a previous surgical operation on the bile ducts had been done, and in 20.5%, the gallbladder was still present. Other indications for EPT were benign and malignant stenosis of the duodenal papilla, and cholangitis in the blind sack syndrome associated with an existing choledochoduodenostomy. The complication rate of EPT was 7.3%. The main complications were pancreatitis, cholangitis, hemorrhage, and perforation. Incarceration of stones or instruments was rare. Most complications could be treated conservatively. The mortality rate at 1.5% was low, and less than that of transduodenal papillotomy. Late complications that occur after transduodenal papillotomy were not found and should not occur after EPT. EPT eliminates the need for laparotomy and represents an alternative for the aged patient in poor general condition.

Management of gallstone disease in the elderly

“…Although in this study the 2 endoscopists were one of each of the above, successful ERCP and duct clearance was lower than that quoted in the literature. 9,[20][21][22][23][24][25][26] Excluding failures, the complication rate in this small series of ERCP was minimal. All of the successfully treated patients, however, remained asymptomatic at the end of the study.…”

“…The 47 patients who had ERCP had a physiological score of 19 (range, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The procedure was successful in 40 (85.1%) patients.…”

Mechanical lithotripsy of large common bile duct stones

“…9 Although sphincterotomy is associated with an increased risk of bleeding and perforation when compared with diagnostic endoscopic retrograde cholangiopancreatography, 10 " the mortality rate for endoscopic sphincterotomy and stone extraction is approximately 1.5%, and the procedure entails a shorter hospitalization than does surgical common bile duct exploration. 12,13 Stones smaller than 1 cm in diameter may pass spontaneously through a sphincterotomy; however, stones larger than 1.5 cm pose a problem for endoscopic retrieval. 10,14 From 5% to 10% of common bile duct stones must be fragmented before endoscopic extraction.…”

Medium term complications of endoscopic biliary sphincterotomy.

“…Endoscopic sphincterotomy (ES) of the papilla of Vater is now an established procedure in the treatment of retained biliary duct stones following cholecystectomy.1 2 Complete duct clearance is often achieved, early complications are few 1 [3][4][5][6] and the mortality and morbidity compare favourably, particularly in elderly patients, with those of surgical re-exploration.4 Endoscopic sphincterotomy has recently been recommended for patients with intact gall bladders who have duct stones, but are unsuitable for surgical treatment, usually because of age or infirmity. 4 The long term sequelae of endoscopic destruction of the sphincter of Oddi, however, are not established; although there is now substantial published experience of endoscopic sphincterotomy, particularly in Europe,5 8 lems since endoscopic sphincterotomy (Table 1).…”