Safety advantage of endocut mode over endoscopic sphincterotomy for choledocholithiasis

doi:10.3748/wjg.v12.i13.2086

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Apr 7, 2006; 12(13): 2086-2088
Published online Apr 7, 2006. doi: 10.3748/wjg.v12.i13.2086

Safety advantage of endocut mode over endoscopic sphincterotomy for choledocholithiasis

Hirotada Akiho, Yorinobu Sumida, Kazuya Akahoshi, Atsuhiko Murata, Jiro Ouchi, Yasuaki Motomura, Taisuke Toyomasu, Mitsuhide Kimura, Masaru Kubokawa, Masahiro Matsumoto, Shingo Endo, Kazuhiko Nakamura

Hirotada Akiho, Yorinobu Sumida, Kazuya Akahoshi, Atsuhiko Murata, Jiro Ouchi, Yasuaki Motomura, Mitsuhide Kimura, Masaru Kubokawa, Masahiro Matsumoto, Shingo Endo, Division of Gastroenterology, Aso Iizuka Hospital, Japan

Taisuke Toyomasu, Division of Surgery, Aso Iizuka Hospital, Japan

Hirotada Akiho, Kazuhiko Nakamura, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Japan

Author contributions: All authors contributed equally to the work.

Correspondence to: Hirotada Akiho, MD, PhD, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. akiho@intmed3.med.kyushu-u.ac.jp

Telephone: +81-92-6425286 Fax: +81-92-6425287

Received: August 31, 2005
Revised: September 21, 2005
Accepted: October 9, 2005
Published online: April 7, 2006

Abstract

AIM: To evaluate whether an automatically controlled cut system (endocut mode) could reduce the complication rate of endoscopic sphincterotomy (EST) and serum hyperamylasemia after EST compared to the conventional blended cut mode.

METHODS: From January 2001 to October 2003, 134 patients with choledocholithiasis were assigned to either endocut mode group or conventional blended cut mode group at the time of sphincterotomy. The two groups were retrospectively compared for the complications after EST and serum amylase level before and 24 h after the procedure.

RESULTS: Of the 134 patients treated, 79 were assigned to conventional blended cut mode group and 55 to endocut mode group. There was no significant difference in age, sex, and serum amylase level before EST between the two groups. Complications were found in 5 patients of the endocut mode group (9%): hyperamylasemia (5 times higher than normal) in 4 and moderate pancreatitis in 1. Complications were found in 13 patients of the conventional blended cut mode group (16%): hyperamylasemia in 12 and moderate pancreatitis in 1. Serum amylase levels were elevated in both groups 24 h after EST (P < 0.02). The average serum amylase level 24 h after EST in the conventional blended cut mode group was significantly higher than that in the endocut mode group (P < 0.05).

CONCLUSION: Endocut mode offers a safety advantage over conventional blended cut mode for pancreatitis after EST by reducing hyperamylasemia.

Keywords: Endocut mode, Endoscopic sphincterotomy, Choledocholithiasis