Endoscopic sphincterotomy and removal of gallstones.

Endoscopic sphincterotomy was attempted in 23 patients. The procedure was successful in 22 patients. Sphincterotomy was not successful in one patient due to the technical inability selectively to cannulate the common bile duct. The indications for sphincterotomy were retained common duct stones after cholecystectomy in 12 patients, recurrent common duct stones after cholecystectomy in nine patients and common bile duct stones with the gallbladder intact in two patients who were prohibitive operative risks. Calculi were completely cleared in 17 of 23 patients at the time of discharge from the hospital following sphincterotomy and ultimately in 19 of 23. There were no complications in 21 of 22 sphincterotomies, although one older patient died of persistent septicemia. A second patient was symptomatically improved but had persistent calculi and died of cardiac causes five months after sphincterotomy. One patient was treated with chenodeoxycholic acid for persistent calculi in the common bile duct after sphincterotomy. Endoscopic sphincterotomy is an effective alternative to conventional surgical procedures for removal of stones of the common bile duct.