The procedure is performcxl with lorn anesthesia and patients do not need to be hospitalized except chose that may be seriously ill. Indications for this procedure arc very precise and care must he extreme.
It is possible 1.0 carrv om this procedure in atients with a nigh Surgical risk and in those in whom attempts to remove the calcuh through Ttube tracts or cndoscoplcally have failed.
REMOVAL OF CALCULI FROM THE COMMON BILE DUCT BY ENDOSCOPIC SPHINCTEROTOMY
Endoscopic sphincrcrotomy was first practiced in 1973 by Classen and Demling, in Germany. At present there is a large body of experience acquired by means of procedure. If the patient does not have a 'ltu be in place this is the procedure of choice. If the patient has a Ttuben place, the Indicated procedure is that of removal of the Calculi through the T1uhtract. Sometimes sphincierotom' is enough for the calculi co be spontaneously inated.
In other cases it is necessary to remove them by a basket at their end.
Removal of calculi by wans of endoscopic sphincierotomy is effective in more than 90, of cases. This procedure should he performed by an experienced endoscopist trained in this therapeutic method. It has been shown that the complications and mortality of this procedure are considerablv higher than those published probably because potlents who become complicated are taken care of by emergency services and arc not brought to rile attention of the cndoscopist performed the procedure.
Complications that can occur due endoscopic spbincrerotomy include hemorrhage. retroperitoneal perforarion. simultaneous hemorrhage and perforation acute cholangitis and acute pancrcatitis.
The patient should be informed of the possibility of these complications and of the possibility that some patients may have robe operated on an emergency basis following endoscopic sphincterotomy. Endoscopic sphlncteroromy should not be performed in patients with altered blood cloning, patients with calculi larger than 20 mm in diameter or in paticnts with stricture of the sphincter of Ockli extend ing beyond the duodenal wall.
Sphincterotomy shoulo not be performed in patients with pcripapillarv duodenal diverticula.