Article Text
Statistics from Altmetric.com
Editor,—Deans et al (Gut1997;41:545–8) have supported the use of endoscopic sphincterotomy for bile duct stones in young people in preference to laparoscopic bile duct exploration. They do this because sphincterotomy causes no more complications in young than in old people. Any comparison between the two methods must also take into account the complications, particularly pancreatitis, that occurred in the remaining two-thirds of the patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) without sphincterotomy. Laparoscopic duct exploration is still a relatively new technique. Rhodes et al reported 129 explorations with one case of postoperative pancreatitis.1 We have had no pancreatitis in 53 explorations. Until larger series are reported judgement is impossible.
For the treatment of bile duct stones a comparison of therapeutic success and the manoeuvres required to achieve it are required on an intention-to-treat basis.
The consequences of sphincterotomy and reflux in the very long term are not known. Most bile duct stones are predominantly composed of pigment, thought to be …
Mr Deans.