Sphincterotomy & Gallstones

Sphincterotomy & Gallstones

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Removing common bile duct gallstones may require a sphincterotomy.

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Your gallbladder stores bile, a fluid produced by your liver that helps your body digest fat. When the bile is needed after a meal, it flows through a tube called the common bile duct into your small intestine. If a bit of hardened bile called a gallstone blocks the common bile duct, you may experience pain in the upper right side of your abdomen, as well as nausea and vomiting. A special procedure called a sphincterotomy is needed to remove the stone.


As many as 10 percent of people with gallstones have one or more stones in the common bile duct. This condition, called choledocholithiasis, can cause biliary colic if a stone blocks the flow of bile through the duct. Symptoms of biliary colic include upper abdominal pain, nausea and vomiting. Some patients also develop jaundice -- yellowing of the skin and the whites of the eyes. Choledocholithiasis can lead to a serious complication called bacterial cholangitis, an infection of the bile duct that requires immediate treatment.


Stones in the common bile duct can be removed by performing a sphincterotomy. While the person is relaxed or asleep from sedatives, a long, flexible tube called an endoscope is inserted through the mouth through the digestive system into the opening of the common bile duct, called the papilla. Contrast dye is injected through the tube to allow x-rays to be taken with a tiny video camera on the end of the endoscope, a procedure called endoscopic retrograde cholangiopancreatography, or ERCP. The sphincterotomy portion of the procedure involves making a small cut into the muscle surrounding the opening of the common bile duct. The cut is made using electrical current through a small wire on a special catheter. This enlargement of the opening allows stones to be extracted using ERCP.


If the person also has stones in the gallbladder, a surgical removal of the gallbladder may be performed after the ERCP with sphincterotomy. Pregnant women can safely undergo ERCP with sphincterotomy, according to the Society of American Gastrointestinal and Endoscopic Surgeons' guidelines for treatment of surgical problems during pregnancy. However, a person with pancreatitis -- inflammation of the pancreas -- may become sicker if ERCP with sphincterotomy is performed before the gallbladder is surgically removed. Instead, the surgeon should wait for several days after gallbladder removal to remove the common duct stones.


Pancreatitis, the inflammation of the pancreas, is the most common complication after ERCP with sphincterotomy. Other complications include infection, bleeding, reaction to the sedatives or perforation of the bowel. The likelihood of developing complications from sphincterotomy depends on the person's general health, severity of gallstone-related symptoms, presence of infection and age. The average rate of ERCP complications that require hospitalization is approximately 6 to 10 percent.


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