Endoscopic retrograde sphincterotomy in the treatment of biliary tract disease.

Endoscopic retrograde sphincterotomy (E.R.S.) is rapidly becoming popular. In the past 5 years, E.R.S. was technically successful in 124 of 130 patients (95%) in whom it was attempted. One hundred twenty four had choledocholithiasis, and six had papillary stenosis after cholecystectomy. Urgent E.R.S. was performed for septic cholangitis in 12 patients and biliary pancreatitis in four. There were six patients with choledocholithiasis in whom sphincterotomy was not possible. Of the 118 patients with successful papillotomy for choledocholithiasis, spontaneous passage of calculi after E.R.S. occurred in 28 cases (24%), and instrumental extraction of stones was possible in 81 (69%). Duct clearance failed in nine patients (8%), mostly due to the large size of the retained stones. The largest stone extracted was 26 mm in diameter. The overall success rate of removing common bile duct stones was 109 in 118 cases (88%). In patients with papillary stenosis, E.R.S. was successful in relieving symptoms and biochemical cholestasis in six of six cases (100%). Complications occurred in only two patients. The complications were pancreatitis in one and hemorrhage in one. None of these patients required surgical treatment of the complication. Endoscopic retrograde sphincterotomy is effective for the removal of stones of the common bile duct, and at relieving the symptoms of papillary stenosis. It is safe in experienced hands and has led to only rare complications.