THE MACRODILATATION OF THE SPHINCTER OF ODDI OR SPHINCTEROPLASTY IN THE TREATMENT OF LARGE STONES OF THE MAIN BILE DUCT

Aims:

Sphincteroplasty consists of a large dilatation of the papilla which completes an endoscopic sphincterotomy in cases of groß choledochal calculus. The aim to evaluate results and complications of sphincteroplasty and associated factors.

Methods:

Retrospective study conducted at the Gastroenterology II between January 2008-March 2017, 48 patients diagnosed with macrocalculations of the main bile duct. Defined by a diameter ≥15 mm and whose treatment required the use of sphincteroplasty. The success of the gesture was defined by the absence of residual calculation at the end of the procedure. The associated factors studied are: age, sex, and diameter of the main bile duct, number of stones, presence of cholangitis, bile duct size disparity, and concept of anterior sphincterotomy.

Results:

The mean age was 63.5 ± 12 years (40 years to 83 years). The sex ratio was 0.7 (28 women, 20 men). 11.3% of the patients included in the studies had a history of cholecystectomy, 6.8% of the patients had gallbladder stones, 57.9% of the patients had multiple stones (≥2), 29.6% had 13.6% patients had an associated endoscopic sphincterotomy, and in 11.3% there was a difference in caliber between the calculation and the diameter of the bile duct downstream. The clinical presentation of the patients was as follows: cholangitis was found in 7 patients; dissociated biliary symptoms suggestive lithiasis migration in 28 patients while 13 patients showed no symptoms. The average number of stones found was 1.86 ± 0.8 per patient with extremes ranging from 1 to 10. Average diameter of the bile duct was 18 ± 4 mm, that of the stones was 18 ± mm, and that of Macrodilating balloon was 16.9 ± 1.5 mm with extremes ranging from 14 to 20 mm.

Conclusions:

Sphincteroplasty effective method at the cost of a low morbidity for the endoscopic extraction of macrocalculations of the main bile duct.