Sphincterotomy

The Procedure

Endoscopic Sphincterotomy is generally performed after ERCP x-rays show a gall stone, or other blockage so the doctor can enlarge the opening of the bile duct. This is called sphincterotomy and is done with an electrically heated wire which you will not feel. Any stones will be collected into a tiny basket or left to pass in the intestine.

STENTING

A stent is a small plastic tube which is pushed through the endoscope and into a narrowed area in the bile duct. This relieves the jaundice, by allowing the bile to drain freely into the intestine. Stents are also sometimes placed in the pancreatic duct when it is narrow or blocked.

NASO-BILIARY TUBE

Sometimes a naso-biliary tube is left in the bile duct and brought out through the nose for a few days. This helps drainage of bile and allows x-rays to check when the duct is clear. The tube may be slightly uncomfortable at first but does not interfere with eating or drinking.

POTENTIAL COMPLICATIONS

These treatments for stones and blockage have been developed and are recommended to you because they are simpler and safer than standard surgical operations. However, you should realise that they are not always successful and problems can arise. Potential complications include perforation of the intestine, bleeding, inflammation of the pancreas (pancreatitis) and infection of the bile duct (cholangitis). These complications are rare, but may be serious enough to require urgent treatment, and even an operation. Death is a remote possibility.

It is very unusual for other biliary problems to develop in the months or years after sphincterotomy, but jaundice, fever and even new stones can rarely occur. Usually these can be dealt with by another endoscopic procedure.

Stents can become blocked with debris after some months. This will result in recurrence of jaundice, usually associated with fevers and chills. If this happens, you should inform us or your local doctor quickly. You will need antibiotics and consideration of stent change.