Endoscopic biliary sphincterotomy : results, complications and contra-indications
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.
|Keywords||cholangiopancreatography, gastroenterology, sphincterotomy|
|Promotor||Schutte, H.E. , Wilson, J.H.P. (Paul)|
|Sponsor||Cook Nederland BV|
|Publisher||Erasmus MC: University Medical Center Rotterdam|
Boender, J.. (1995, April 19). Endoscopic biliary sphincterotomy : results, complications and contra-indications. Erasmus MC: University Medical Center Rotterdam. Retrieved from http://hdl.handle.net/1765/21503