Endoscopic papillotomy for recurrent common bile duct stones and papillary stenosis. A community hospital experience

R. J. Mazzeo, F. T. Jordan and S. R. Strasius

Fifty-nine papillotomies were performed, 56 for biliary tract disease and three for papillary stenosis (secondary to carcinoma in two cases). All 56 patients with biliary tract disease had undergone previous cholecystectomies. Fifty-one of them had stones in the common duct, and in 41, all identified stones were removed. Stones were retained in ten patients, four of whom required surgical biliary tract exploration for extraction. Our results indicate that common bile duct stones with diameters 2.5 cm or greater should be approached surgically. Endoscopic papillotomy had an initial success rate of 80% for extraction of common bile duct stones and a late or actual success rate of 92%, confirmed by cholangiography. There were nine complications, including five episodes of bleeding (three requiring surgical intervention for control), giving an overall morbidity rate of 15.2%. The mortality was 3.4%. The procedure is indicated in the treatment of papillary stenosis and stones retained in the common bile duct after cholecystectomy.