Endoscopic sphincteroclasy for choledocholithiasis of the principal bile duct. Short-term results and follow-up]

The hydrostatic dilatation of the papilla of Vater, or sphincteroclasy, has been recently proposed as an alternative to endoscopic sphincterotomy. Our aim was to assess short term results and follow-up after sphincteroclasy for choledocholithiasis.From August, 1994 to December, 1996, 52 patients were included for endoscopic therapy of choledocholithiasis (mean age 66 +/- 17 years). Patients were prospectively followed on the short term-period (24 h, 48 h and 30 days) and longer term after treatment (every 6 months) by clinical and biological controls.Forty-eight sphincteroclasies were performed successfully (92.3%). Thirty seven patients had a choledocolithiasis. Eleven were stone-free. Eight had undergone former gastric surgery and 8 had impaired coagulation test. Complete stone clearance was achieved in 98% of patients. Mild pancreatitis were observed in three patients (6.25%). Thirty-day mortality was nil. Long term follow-up (mean 21.4 +/- 7 months) revealed: 2 patients with cholecystitis 6 and 13 months after treatment, one of which was followed 8 months later by a fatal septic shock, and 3 patients with cholangitis, 2 of which in the same patient, 9, 12 and 24 months after sphincteroclasy. The global long term biliary complication rate was 8.4%, 4.2% of which were potentially related to the endoscopic procedure.Sphincteroclasy is an efficient procedure for the treatment of choledocholithiasis. Its short term results are similar to those of endoscopic sphincterotomy. Complications after 2 years appear to be scarce, but longer follow-up is required before routinely performing sphincteroclasy.