Endoscopic papillotomy.

Endoscopic papillotomy is nine years old. During this time it obtained a well defined place in the treatment of common bile duct stones and of papillary stenosis. In about 85% this method proved to be successful without any problems. To lower the risk and to improve the results now smaller steps must be done. Within the last 4 years we have learned to manage even big stones with a reduced risk by stone dissolution and by a new lithotripsy device. Biliary pancreatitis has become an indication for an early duodenoscopy and even papillotomy. Acute obstructive suppurative cholangitis may be treated by endoscopy with a lower risk than by surgical intervention. Even the feared Dormia basket impaction in most cases is no longer an indication for an emergency operation. Mostly it can be treated by a second endoscope together with a new cutting device designed by Mr. Mori. All these small steps have improved the success rate of papillotomy from 94% to 99%, rate of definite stone management from 87% to 92%, reducing the complication rate from 8% to 4% at the same time.