Problems in endoscopic sphincteropapillotomy.

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.