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World J Gastroenterol. Jun 14, 2007; 13(22): 3106-3111
Published online Jun 14, 2007. doi: 10.3748/wjg.v13.i22.3106
Selective sphincteroplasty of the papilla in cases at risk due to atypical anatomy
F Mugica, G Urdapilleta, A Castiella, A Berbiela, F Alzate, E Zapata, L Zubiaurre, P Lopez, JI Arenas
F Mugica, F Alzate, E Zapata, L Zubiaurre, P Lopez, JI Arenas, Gastroenterology Department, Donostia Hospital, San Sebastian, Spain
G Urdapilleta, Surgery Department, Donostia Hospital, San Sebastian, Spain
A Castiella, Gastroenterology Department, Bajo Deva Hospital, Spain
A Berbiela, Anaesthesia Department, Donostia Hospital, San Sebastian, Spain
Author contributions: All authors contributed equally to the work.
Correspondence to: F Mugica, Servicio de Digestivo, Hospital Donostia, Avenida Dr Beguiristain 20080, Donostia-San Sebastián, Spain. fmugica@chdo.osakidetza.net
Telephone: +34-94-3007173 Fax: +34-94-3007065
Received: February 7, 2007
Revised: February 25, 2007
Accepted: March 8, 2007
Published online: June 14, 2007
Abstract

AIM: To analyze the indications, efficacy and safety of sphincteroplasty in our centre.

METHODS: A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the filling pressure.

RESULTS: The indications included intradiverticular papilla in 26 patients (49%), stenosis of a previous sphincterotomy in 19 patients (35.8%), small size of the papilla in 4 patients (7.5%), Billroth II gastrectomy in 3 patients (5.6%), and coagulopathy in one patient (1.9%). The efficacy was 97.8%, with all the calculi extracted from the common bile duct in 84.4% of the patients, even though 21 of the patients (39.6%) had calculi with a diameter equal to or greater than 10 mm. Seven patients (13.2%) presented complications: haemorrhage in 1 patient (1.9%) and mild pancreatitis in 6 patients (11.3%). The mean hospital stay in case of complications was of 3 ± 0.63 d.

CONCLUSION: Sphincteroplasty is highly effective, with a complication rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort to lithotripsy or rescue sphincterotomy.

Keywords: Sphincteroplasty; Hydrostatic dilatation of the papilla; Choledocholithiasis; Sphincterotomy; Function of the sphincter of Oddi; Acute pancreatitis; Intradiverticular papilla