What is Endoscopic Sphincterotomy?

Endoscopic sphincterotomy is a minimally invasive surgical procedure where instruments and a camera for visualizing the surgical site are inserted through small incisions to allow a surgeon to correct a problem with the common bile duct. During the procedure, an incision is made in the Sphincter of Oddi, a structure that permits drainage from the common bile duct and pancreatic duct, allowing the surgeon to see inside and to extract blockages, in addition to releasing blocked bile. This procedure is usually performed by a specialist, although a general surgeon may offer it as well.

This procedure is indicated when a patient clearly has a biliary obstruction. Symptoms of a bile duct obstruction can include nausea, abdominal pain, dark urine, and pale stools. Historically, invasive surgeries were required to identify and correct the obstruction and the risks for the patient could be high. With the development of endoscopic surgical procedures, doctors had access to a much safer surgical technique. Endoscopic sphincterotomy was used originally as a diagnostic tool, with the doctor inserting the camera through the incision in the sphincter to see what was happening inside the patient. Today, it is used in treatment of biliary obstructions.

When the flow of bile is interrupted by a blockage at or above the Sphincter of Oddi, endoscopic sphincterotomy can allow a surgeon to remove bile stones, a common source of blockages. This type of procedure also allows the surgeon to also address strictures, narrowings of the duct that make it harder for the patient's bile to move freely into the intestinal tract. The space is small and narrow, and the surgeon needs to be experienced with endoscopies to avoid injuring the patient during the surgery.

Risks of an endoscopic sphincterotomy can include infection, tears, or other injuries to the bile duct and neighboring tissues, and adverse reactions to the anesthetics used during the surgery. Patients can reduce their risks by fully discussing their medical histories with the surgeon and anesthesiologist before the endoscopic sphincterotomy, following aftercare directions carefully, and working with an experienced surgeon who has performed this procedure before.

After the procedure is performed, the patient should experience relief from the bile duct obstruction and will be much more comfortable. Patients with a history of bile stones are often advised to watch out for warning signs in the future, as they can recur. If bile stones become a chronic problem, other treatment options may need to be explored to address the problem.