Biliary endoscopic sphincterotomy

Biliary endoscopic sphincterotomy is a procedure where the sphincter of Oddi and the segment of the common bile duct where it enters the duodenum are cannulated and then cut with a sphincterotome, a device that includes a wire which cuts with an electric current (electrocautery). This procedure was developed in both Germany and Japan and was first published in each nation in 1974. It has become a very common technique, useful for treatment of a wide variety of conditions of the biliary system such as the evacuation of gallstones within the bile duct (choledocholithiasis), biliary or papillary strictures, sphincter of Oddi dysfunction, bile leaks, and others. In addition, it is commonly performed during an endoscopic retrograde cholangiopancreatography (ERCP), and it may be used for facilitating diagnostic procedures such as transpapillary bile duct biopsy, papillary tumor biopsy, and insertion of a cholangioscope. Extraction of choledocholithiasis and/or intrahepatic stones: choledocholithiasis is the presence of gallstones within the common bile duct. They can be either primary (formed within the duct) or secondary (entering the duct from the gallbladder). Biliary endoscopic sphincterotomy allows for opening of the sphincter of Oddi, allowing stones to be removed. Treatment of benign biliary/papillary strictures: diseases such as primary sclerosing cholangitis can lead to fibrosis and stricture of the ducts of the biliary tree. These strictures can cause cholestasis which can lead to jaundice, pruritus, cholangitis, and gallstone formation. Biliary endoscopic sphincterotomy is sometimes used, with or without stenting, to relieve the obstruction, but systematic reviews have not demonstrated consistent benefits. Treatment of sphincter of Oddi dysfunction: this is a diagnosis of exclusion which encompasses a broad spectrum of hepatobiliary disorders including spasms, strictures, or inappropriate relaxation. Sphincterotomy appears to be safe and effective for the treatment of sphincter of Oddi dysfunction.