What is the role of sphincterotomy in the treatment of gallstones (cholelithiasis)?

Updated: Apr 01, 2019
  • Author: Douglas M Heuman, MD, FACP, FACG, AGAF; Chief Editor: BS Anand, MD  more...
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If surgical removal of common bile duct stones is not immediately feasible, endoscopic retrograde sphincterotomy can be used. In this procedure, the endoscopist cannulates the bile duct via the papilla of Vater. Using an electrocautery sphincterotome, the endoscopist makes an incision measuring approximately 1 cm through the sphincter of Oddi and the intraduodenal portion of the common bile duct, creating an opening through which stones can be extracted.

Endoscopic retrograde sphincterotomy is especially useful in patients who are critically ill with ascending cholangitis caused by impaction of a gallstone in the ampulla of Vater. Other indications for the procedure are as follows:

  • Removal of common bile duct stones inadvertently left behind during previous cholecystectomy

  • Preoperative clearing of stones from the common bile duct to eliminate the need for intraoperative common bile duct exploration, especially in situations where the surgeon's expertise in laparoscopic bile duct exploration is limited or the patient's anesthesia risk is high

  • Preventing recurrence of acute gallstone pancreatitis or other complications of choledocholithiasis in patients who are too sick to undergo elective cholecystectomy or whose long-term prognosis is poor

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