Endoscopic papillotomy. Experimental studies and initial clinical experience.

Experimental studies carried out in 11 dogs have shown that, with the aid of a high frequency diathermy probe, satisfactory papillotomies can be performed. On the basis of these results, endoscopic papillotomies have been carried out in 23 patients. Indications for papillotomy were biliary calculi in 11 high-risk patients, in 6 cases calculi overlooked during bile duct surgery, and in 3 patients recurrent calculi after previous cholecystectomy. In 3 patients circumscribed papillary stenosis indicated endoscopic papillotomy. Papillotomy was successful in all 23 cases. In 9 cases the calculi had been passed spontaneously after 3-5 days. In 10 patients the stones had to be extracted using the Dormia basket or a wire loop, and in one patient the stone had to be removed surgically. In one of these patients endoscopic papillotomy was followed by an attack of pancreatitis which subsided after 3 days. Further complications, in particular the occurrence of massive bleeding after papillotomy, were not observed.