thesis
Endoscopic biliary sphincterotomy : results, complications and contra-indications
- Publication date
- 19 April 1995
- Publisher
- In 1986 the departments of Radiology and Internal Medicine II/Gastroenterology
initiated a prospective study of therapeutic endoscopic retrograde cholangiopancreatography
(TERCP). The project was designed to obtain information which
could be used to evaluate immediate and medium-term results and complications
of endoscopic biliary and pancreatic interventions. During a three-year period 1362
consecutive patients undergoing endoscopic retrograde cholangiopancreatography
(ERCP) were included, and a large amount of information gathered in a standard,
prospective fashion. This information was then used to answer specific questions
or solve specific problems, most of which concerned cutting the papilla of Vater
during TERCP to improve access to the common bile duct or main pancreatic duct.
The main aim of the work reported in this thesis was therefore to evaluate the
results of endoscopic biliary sphincterotomy in patients with common bile duct
obstruction due to malignancy or stones, with and without cholangitis, and patients
suspected of biliary dyskinesia. The studies focussed especially on complications
due to the intervention.
A general introduction and a review of the literature is given in chapter 2.
Chapter 3 describes the patients and the protocol used for the therapeutic ERCP
study.
In chapter 4 the problems encountered during endoscopic stenting in patients
with malignant obstruction of the mid or distal common bile duct and/or the papilla
are assessed.
Chapter 5 describes the complications observed in patients after endoscopic
papillotomy (= endoscopic sphincterotomy) for common bile duct stones and how
to prevent them.
In chapter 6 the risk factors influencing complications of sphincterotomy in
patients with cholangitis due to common bile duct stones are assessed.
Follow-up results of endoscopic papillotomy in patients suspected of having a
functional disorder of the papilla are described in chapter 7.
Patients with a history of Biliroth II gastrectomy present special problem when
they have to undergo sphincterotomy. A technique to succesfully perform
sphincterotomy in these patients is described in chapter 8.
Finally the results and complications of endoscopic papillotomy presented in
the previous chapters are discussed and summarized.