Data regarding complications after the extension of a previous endoscopic biliary sphincterotomy are limited and controversial.
|Overall complication rate:|
- repeat sphincterotomy = 2%
- sphincterotomy = 8%
|American Journal of Gastroenterology|
In this study, a research team from Greece prospectively studied complications after repeat sphincterotomy in 81 patients.
They then compared them with those of biliary endoscopic sphincterotomy in 250 consecutive patients with choledocholithiasis.
All patients had choledocholithiasis and were enrolled using specific criteria, excluding parameters predisposing to increased postsphincterotomy complications.
The research team found that the overall complication rate was 2% in the repeat sphincterotomy and 8% in the sphincterotomy group.
They identified complications as bleeding (2% and 3%), pancreatitis (0% and 5%), cholangitis (0% and 0.4%), perforation (0% and 0.4%), and hyperamylasemia (4% and 13%) for the repeat sphincterotomy and initial sphincterotomy, respectively.
The team found that bleeding episodes occurred when the repeat sphincterotomy was performed soon after the first.
Dr Christos Mavrogiannis's team concluded that, "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".