Clinical Study On Complications After Endoscopic Sphincterotomy

ObjectiveThe aim of the study was to investigate the complications of endoscopic sphincterotomy(EST),and analyze its high risk factors which can induce complications,especially post-endoscopic pancreatitis.To observe the rate of bile duct stone recurrence after endoscopic sphincterotomy,and to detect predictors for recurrent bile duct stones.The aim of this randomized trial was to compare the success and the complication rates of needle-knife sphincterotomy and pancreatic sphincter precutting in achieving cannulation of an otherwise inaccessible bile duct. And to evaluate the efficacy and safety of pancreatic sphincter precutting.MethodsA total of 3075 patients executed EST between June 1998 and Septemble 2005 in TianJin Minimal Invasive Surgery center were studied retrospective and counted how many of them occurred with acute pancreatitis,bleeding,perforation, cholecystitis,cholangitis.A total of 453 consecutive patients who underwent EST for bile duct stones from June 1998 to October 1999 were prospectively followed up.To observe the rate of bile duct stone recurrence after endoscopic sphincterotomy,and to detect predictors for recurrent bile duct stones.A Total of 219 patients with inaccessible bile ducts underwent pre-cut sphincterotomy either by needle-knife sphincterotomy(n=113)or Pancreatic sphincter precutting.(n=106).The outcomes measured were success rate and complications.ResultComplications occurred in 208 cases(6.76%)of 3075 patients who underwent endoscopic sphincterotomy:acute pancreatitis occurred in 97 cases(3.15%), bleeding occurred in 34 cases(1.11%),perforation occurred in 5 cases(0.16%), cholecystitis occurred in 65 cases(2.11%),cholangitis occurred in 7 cases(0.23%). Multivariate analysis show:SOD,pancreatic duct contrast injection,anomalous pancreaticobiliary junction are the independent risk factors for acute pancreatitis, normal duct diameter,needle-knife sphincterotomy,pancreatic sphincter precutting don't seem be risk factors.In 209 of 219(95.4%)patients,the bile duct was selectively cannulated after pre-cut sphincterotomy.The bile duct was cannulated in 104 of 106(98.1%)patients randomized to pancreatic sphincter precutting and 105 of 113(92.9%)patients who underwent needle-knife sphincterotomy.ConclusionSphincter of oddi dysfunction(SOD),pancreatic duct contrast injection,anomalous pancreaticobiliary junction was significantly related to occurrences of acute pancreatitis.But needle-knife technique,pancreatic sphincter precutting does not increase the risk of incidence of acute pancreatitis after sphincterotomy.After EST, cholecystitis should be cautioned in patients with gall bladder stone.Patients who underwent prior cholecystectomy and has calculous gall bladder,lithotripsy, pneumobilia should pay more attention to recurrence of bile duct stones.Carefully followed up was recommended.Endoscopic therapy was the best choice.Compared with standard needle-knife sphincterotomy,Pancreatic sphincter precutting has a significantly higher rate of bile duct cannulation and a lower complication rate,is an effective and safe technique for patients in whom selective cannulation of the common bile duct has failed.