Special Report
Endoscopic sphincterotomy complications and their management: an attempt at consensus

https://doi.org/10.1016/S0016-5107(91)70740-2Get rights and content

Despite its relative safety (in comparison with surgery), and undoubted role in many clinical circumstances, biliary sphincterotomy is the most dangerous procedure routinely performed by endoscopists. Complications occur in about 10% of patients; 2 to 3% have a prolonged hospital stay, with a risk of dying. This document is an attempt to provide guidelines for prevention and management of commplications, based on a workshop of selected experts, and a comprehensive review of the literature. We emphasize particularly the importance of specialist training, disinfection, drainage, and collaboration with surgical colleagues.

References (102)

  • J.P. Neoptolemos et al.

    Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative management for acute pancreatitis due to gallstones

    Lancet

    (1988)
  • I. Hamilton et al.

    Acute pancreatitis following endoscopic retrograde cholangiopancreatography

    Clin Radiol

    (1983)
  • J.I. Allen et al.

    Pseudomonas infection of the biliary system resulting from use of a contaminated endoscope

    Gastroenterology

    (1987)
  • V.F. Moreira et al.

    ERCP and allergic reactions to iodized contrast media

    Gastrointest Endosc

    (1985)
  • J.E. Geenen

    A/S/G/E distinguished lecture—endoscopic therapy of pancreatic disease; a new horizon

    Gastrointest Endosc

    (1988)
  • G.L. French et al.

    Antibiotics for cholangitis

    Lancet

    (1989)
  • R.H. Hawes et al.

    Follow-up 6–11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy

    Gastroenterology

    (1990)
  • B.M. Schuman

    The evolution of diagnostic ERCP

    Gastrointest Endosc

    (1990)
  • P.B. Cotton

    Therapeutic endoscopy in the 1990s: objectivity, teaching, and service

    Gastrointest Endosc

    (1991)
  • M. Classen et al.

    Endoskopische Sphinkterotomie der papilla vateri und Steinextraktion aus dem ductus choledochus

    Dtsch Med Wochenschr

    (1974)
  • P.B. Cotton

    Endoscopic management of bile duct stones; (apples and oranges)

    Gut

    (1984)
  • P.B. Cotton

    Non-operative removal of bile duct stones by duodenoscopic sphincterotomy

    Br J Surg

    (1980)
  • B. Neuhaus et al.

    Complications of endoscopic sphincterotomy and their treatment

    Endoscopy

    (1981)
  • P.B. Cotton et al.

    Computer analysis of a decade of ERCP

    Gut

    (1981)
  • J. Escourrou et al.

    Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gallbladder ‘in situ’

    Gut

    (1984)
  • I.C. Roberts-Thomason

    Endoscopic sphincterotomy of the papilla of Vater: an analysis of 300 cases

    Aust NZ J Med

    (1984)
  • T. Leese et al.

    Successes, failures, early complications and their management following endoscopic sphincterotomy: results in 394 consecutive patients from a single centre

    Br J Surg

    (1985)
  • K.I. Shults

    The experience of use of endoscopic papillotomy

    Klin Med (Mosk)

    (1987)
  • D. Vaira et al.

    Endoscopic sphincterotomy in 1000 consecutive patients

    Lancet

    (1989)
  • Lambert ME, Betts CD, Hill J, Faragher EB, Martin DF, Tweedle DEF. Endoscopic sphincterotomy: the whole truth. Br J...
  • P.B. Cotton

    Complications, comparisons and confusion: a commentary

  • E.C.S. Lai

    Management of severe acute cholangitis

    Br J Surg

    (1990)
  • B.R. Davidson et al.

    Endoscopic sphincterotomy for common bile duct calculi in patients with gallbladder in situ considered unfit for surgery

    Gut

    (1988)
  • J.H. Siegel et al.

    Duodenoscopic sphincterotomy in patients with gallbladders in situ reported a series of 1272 patients

    Am J Gastroenterol

    (1988)
  • L. Beaugerie et al.

    Lithiase de la voie biliaire principale du sujet age traitee par voie endoscopique (277 malades)

    Gastroenterol Clin Biol

    (1988)
  • J.F. Gigot et al.

    Acute cholangitis. Multivariate analysis of risk factors

    Ann Surg

    (1989)
  • S.L. Blamey et al.

    Prediction of risk in biliary surgery

    Br J Surg

    (1983)
  • J.P. Neoptolemos et al.

    A multivariant analysis of preoperative risk factors in patients with common bile duct stones

    Ann Surg

    (1989)
  • P.E. Krims et al.

    Papillotomy and functional disorders of the sphincter of Oddi

    Endoscopy

    (1988)
  • J.P. Neoptolemos et al.

    Sphincter of Oddi dysfunction: results of treatment by endoscopic sphincterotomy

    Br J Surg

    (1988)
  • A.S. Mee et al.

    Non-operative removal of bile duct stones by duodenoscopic sphincterotomy in the elderly

    Br Med J

    (1981)
  • K. Huibregtse

    Endoscopic biliary and pancreatic drainage

    (1988)
  • I.M. Jacobson

    Endoscopic sphincterotomy in patients with intact gallbladders

  • P.B. Cotton

    Retained bile duct stones; T-tube in place. Percutaneous or endoscopic management?

    Am J Gastroenterol

    (1990)
  • D. Vaira et al.

    Is duodenal diverticulum a risk factor for sphincterotomy?

    Gut

    (1989)
  • E. Shemesh et al.

    Endoscopic sphincterotomy in patients with gallbladder in situ: the influence of periampullary duodenal diverticula

    Surgery

    (1990)
  • L. Safrany et al.

    Endoscopic sphincterotomy in patients with Billroth II gastrectomy

    Endoscopy

    (1980)
  • M. Osnes et al.

    Endoscopic retrograde cholangiography and endoscopic papillotomy in patients with a previous Billroth-II resection

    Gut

    (1986)
  • Tweedle DEF, Martin DF. Pre-cut papillotomy for endoscopic sphincterotomy and cholangiography. Gastrointest Endosc (in...
  • J.W.C. Leung et al.

    Pre-cut (needle knife) papillotomy for impacted common bile duct stone at the ampulla

    Am J Gastroenterol

    (1990)
  • Cited by (2560)

    View all citing articles on Scopus
    View full text