Endoscopic sphincterotomy complications and their management: an attempt at consensus

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,...

https://www.nejm.org/doi/pdf/10.1056/NEJM199609263351301

Complications of Endoscopic Biliary Sphincterotomy

International variations in cancer rates have been attributed, at least in part, to differences in dietary intake. Recently, it has been suggested that consumption of soyfoods may contribute to the relatively low rates of breast, colon, and prostate cancers in countries such as China and Japan. Soybeans contain a number of anticarcinogens, and a recent National Cancer Institute workshop recommended that the role of soyfoods in cancer prevention be investigated. In this review, the hypothesis that soy intake reduces cancer risk is considered by examining relevant in vitro, animal, and epidemiological data. Soybeans are a unique dietary source of the isoflavone genistein, which possesses weak estrogenic activity and has been shown to act in animal models as an antiestrogen. Genistein is also a specific inhibitor of protein tyrosine kinases; it also inhibits DNA topoisomerases and other critical enzymes involved in signal transduction. In vitro, genistein suppresses the growth of a wide range of can...

Soy intake and cancer risk: A review of the in vitro and in vivo data

https://www.giejournal.org/article/S0016-5107(01)70371-9/pdf

Total enteroscopy with a nonsurgical steerable double-balloon method

A BSTRACT 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. (N Engl J Med 1996;335:909-18.)

Complications of endoscopic biliary sphincterotomy.

Endoscopic sphincterotomy of the ampulla of Vater

Direct endoscopic visualization of the bile and pancreatic duct systems by peroral cholangiopancreatoscopy (PCPS)

Endoscopic examination using a specially designed sonde-type small intestinal fiberscope (SSIF, Olympus) was performed in 37 patients of our clinic. The improvement of the scope has enabled us to observe the greater parts of the small intestine within a short time and without hazard to the patient. Therefore, with further improvement of this instrument and the insertion technique, we will be able to inspect all parts of the small intestinal mucosa and diagnose the lesions more easily.

Clinical evaluation of a sonde-type small intestinal fiberscope.

Five years experience of Endoscopic Sphincterotomy (EST) in Japan has been analyzed in 468 collective cases from 25 centres. In the indication of EST, biliary tract stones were the main reason, and shared in 92.5% of the success of EST. Other applications were benign stenosis of the papilla of Vater, ascaris of the common bile duct and so on where these formed a small group in the indication of EST. Complete removal of stones had been observed spontaneously in 62.3% of the cases, and with the help of a basket or balloon catheter in 23.7% of successful EST. However, fourteen percent of EST had no effect on the delivery of gallstones. Complications during and after EST were observed in 8.5% of all cases where hemorrhage, pancreatitis and cholangitis were the main hazards. The mortality rate was 0.4%, a considerably low rate when the figure is simply compared with that of cases involving surgical intervention. Finally, the term of Endoscopic Sphincterotomy (EST) was proposed for this procedure because it proved to be the best expression of the actual procedure.

Yuzo Akasaka

Papers

Endoscopic sphincterotomy of the ampulla of Vater

Direct endoscopic visualization of the bile and pancreatic duct systems by peroral cholangiopancreatoscopy (PCPS)

Clinical evaluation of a sonde-type small intestinal fiberscope.

Five years experience of endoscopic sphincterotomy in Japan: a collective study from 25 centres.

New Trial for Endoscopical Observation of Esophagus by Dye Scattering Method