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Volume 335:909-919 September 26, 1996 Number 13 Next

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ABSTRACT

Background Endoscopic sphincterotomy is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated risk factors for complications of this procedure and their outcomes.

Methods We studied complications that occurred within 30 days of endoscopic biliary sphincterotomy in consecutive patients treated at 17 institutions in the United States and Canada from 1992 through 1994.

Results Of 2347 patients, 229 (9.8 percent) had a complication, including pancreatitis in 127 (5.4 percent) and hemorrhage in 48 (2.0 percent). There were 55 deaths from all causes within 30 days; death was directly or indirectly related to the procedure in 10 cases. Of five significant risk factors for complications identified in a multivariate analysis, two were characteristics of the patients (suspected dysfunction of the sphincter of Oddi as an indication for the procedure and the presence of cirrhosis) and three were related to the endoscopic technique (difficulty in cannulating the bile duct, achievement of access to the bile duct by "precut" sphincterotomy, and use of a combined percutaneous–endoscopic procedure). The overall risk of complications was not related to the patient's age, the number of coexisting illnesses, or the diameter of the bile duct. The rate of complications was highest when the indication for the procedure was suspected dysfunction of the sphincter of Oddi (21.7 percent) and lowest when the indication was removal of bile-duct stones within 30 days of laparoscopic cholecystectomy (4.9 percent). As compared with those who performed fewer procedures, endoscopists who performed more than one sphincterotomy per week had lower rates of complications (8.4 percent vs. 11.1 percent, P = 0.03).

Conclusions The rate of complications after endoscopic biliary sphincterotomy can vary widely in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique, rather than to the age or general medical condition of the patient.

Source Information

From the Hennepin County Medical Center, Minneapolis (M.L.F., J.D.L., A.M.P.); the Minneapolis Veterans Affairs Medical Center, Minneapolis (D.B.N.); Indiana University Medical Center, Indianapolis (S.S.); Wellesley Hospital, Toronto (G.B.H.); the University of Minnesota Hospital and Clinic, Minneapolis (M.E.H.); St. Cloud Clinic of Internal Medicine, St. Cloud, Minn. (P.J.D.); Duluth Clinic, Duluth, Minn. (J.P.M.); the University of Arizona, Tucson (M.B.F.); the Marshfield Clinic, Marshfield, Wis. (M.E.R.); and Park Nicollet Clinic, Minneapolis (M.J.S.). Other contributing authors were Robert D. Mackie, M.D., Digestive Health Care, Minneapolis; Joanne C. Imperial, M.D., California Pacific Medical Center, San Francisco; Stephen E. Silvis, M.D., Minneapolis Veterans Affairs Medical Center, Minneapolis; Paul P. Kortan, M.D., Wellesley Hospital, Toronto; William B. Silverman, M.D., University of Pittsburgh, Pittsburgh; John T. Cunningham, M.D., Medical University of South Carolina, Charleston; James A. DiSario, M.D., University of Utah Medical Center, Salt Lake City; Priya A. Jamidar, M.D., University of California at Los Angeles, Los Angeles; Paul N. Yakshe, M.D., University of Minnesota Hospital and Clinic, Minneapolis; and George M. Logan, M.D., St. Paul–Ramsey Medical Center, St. Paul, Minn. Institutions and endoscopists participating in the study are listed in the Appendix.

Address reprint requests to Dr. Freeman at the Department of Medicine, Hennepin County Medical Center, 701 Park Ave., Minneapolis, MN 55415.

Full Text of this Article

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