Document Detail

Safety of extension of a previous endoscopic sphincterotomy: a prospective study.
MedLine Citation:
PMID:  12526939     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Data in the literature regarding complication risks after the extension of a previous endoscopic biliary sphincterotomy (repeat endoscopic biliary sphincterotomy) are limited and controversial. To explore this issue, we prospectively studied complications after repeat sphincterotomy and compared them with those of biliary endoscopic sphincterotomy in consecutive patients with choledocholithiasis. METHODS: A total of 250 patients underwent endoscopic biliary sphincterotomy and 81 underwent extension of a previous one. All patients had choledocholithiasis and were enrolled using specific criteria, excluding parameters predisposing to increased postsphincterotomy complications. RESULTS: The overall complication rate was 2.46% in the repeat sphincterotomy and 8.4% in the sphincterotomy group (p > 0.05). Complications for the repeat sphincterotomy and initial sphincterotomy groups, respectively, were as follows: bleeding, 2.46% and 2.8%; pancreatitis, 0% and 4.8% (p < 0.05); cholangitis, 0% and 0.4%; perforation, 0% and 0.4%; and hyperamylasemia, 3.7% and 12.8% (p < 0.05). There were no deaths. Bleeding episodes in the former group occurred when repeat sphincterotomy was performed early after the primary one. CONCLUSIONS: Repeat sphincterotomy is a safe technique for the treatment of patients with choledocholithiasis and seems to be as safe as initial sphincterotomy. It is not associated with increased hemorrhage risk. There is a trend toward a higher risk of hemorrhage when repeat sphincterotomy is performed early. Repeat sphincterotomy is safer than the initial sphincterotomy with respect to pancreatic complications.
Christos Mavrogiannis; Christos Liatsos; Ioannis S Papanikolaou; Dimitris I Psilopoulos; Spyros S Goulas; Andreas Romanos; Gerasimos Karvountzis
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  98     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-01-15     Completed Date:  2003-03-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  72-6     Citation Subset:  IM    
Department of Gastroenterology, Hippokration General Hospital, Athens, Greece.
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MeSH Terms
Aged, 80 and over
Gallstones / surgery*
Middle Aged
Prospective Studies
Sphincterotomy, Endoscopic / adverse effects*,  methods*,  standards
Comment In:
Am J Gastroenterol. 2003 Aug;98(8):1894-5; author reply 1895-6   [PMID:  12907354 ]

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