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Endoscopic Sphincterotomy

  • Author: Priya A Jamidar, MD, FACG, FASGE; Chief Editor: Kurt E Roberts, MD  more...
 
Updated: Dec 03, 2015
 

Background

Endoscopic biliary sphincterotomy was first reported in 1974. Approximately 150,000 patients undergo endoscopic biliary sphincterotomy in the United States each year. Sphincterotomy is a complex procedure that incorporates the use of endoscopic as well as fluoroscopic guidance. The technique involves deep cannulation of the bile duct followed by severance of the sphincter of Oddi with the electrocautery. This topic focuses on preparation for, as well as the technique involved in, endoscopic biliary sphincterotomy.

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Indications

The primary indications for endoscopic sphincterotomy include extraction of common bile duct stones, treatment of papillary stenosis, and facilitation of endotherapy (ie, stent placement, tissue sampling, and stricture dilation).

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Contraindications

Recent myocardial infarction, severe cardiopulmonary disease, recent attack of acute pancreatitis, and contrast dye exposure causing anaphylaxis are contraindications.

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Contributor Information and Disclosures
Author

Priya A Jamidar, MD, FACG, FASGE Professor of Medicine, Director of Endoscopy, Associate Section Chief, Section of Digestive Diseases, Yale University School of Medicine

Disclosure: Received honoraria from Boston Scientific for speaking and teaching; Received honoraria from Olympus America for speaking and teaching.

Coauthor(s)

Jason E Kinzel, MD Fellow in Gastroenterology, Department of Digestive Diseases, Yale-New Haven Hospital, Yale University School of Medicine

Jason E Kinzel, MD is a member of the following medical societies: American Medical Association, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Kurt E Roberts, MD Assistant Professor, Section of Surgical Gastroenterology, Department of Surgery, Director, Surgical Endoscopy, Associate Director, Surgical Skills and Simulation Center and Surgical Clerkship, Yale University School of Medicine

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

Medscape Reference thanks Dawn Sears, MD, Associate Professor of Internal Medicine, Division of Gastroenterology and Hepatology, Scott and White Memorial Hospital; and Dan C Cohen, MD, Fellow in Gastroenterology, Scott and White Hospital, Texas A&M Health Science Center College of Medicine, for assistance with the video contribution to this article

References
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  14. Langerth A, Sandblom G, Karlson BM. Long-term risk for acute pancreatitis, cholangitis, and malignancy more than 15 years after endoscopic sphincterotomy: a population-based study. Endoscopy. 2015 Jul 10. [Medline].

  15. Grund, KE, Farin, G. New principles and application of high frequency surgery, including argon plasma coagulation. Annual of gastrointestinal endoscopy. 10th. Rapid Science Publishers; 1997.

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This video, captured via endoscopic retrograde cholangiopancreatography, shows a sphincterotomy being performed. The sphincter of Oddi is being cut using electrocautery applied to the biliary cannulation catheter. Video courtesy of Dawn Sears, MD, and Dan C. Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
 
 
 
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