Endoscopic sphincterotomy and gall stone removal.

CALCULI in the common bile duct are extremely common. Although such stones are overlooked at operation in only about 5 per cent of cases, the frequency of gall stone surgery means that there are many patients with retained stones.' Stones may rarely form within the biliary system after cholecystectomy. Removal of retained or reformed stones is important because of their morbid potential-cholangitis, hepatic abscess, biliary cirrhosis or pancreatitis. Until recently surgical management has been the only successful method of treatment. Exploration of the common duct increases the morbidity and mortality associated with biliary surgery.2 Moreover the risks increase with age and the presence of jaundice and indeed those patients requiring surgery for choledocholithiasis are frequently both old and jaundiced. Endoscopic retrograde cholangiopancreatography is helpful in the evaluation of such patients. Removal of gall stones from the common bile duct by endoscopy is being done with increasing frequency and studies to date have shown this to be a relatively safe and effective means of extracting retained stones from the common bile duct.3 This paper reports our experience with endoscopic sphincterotomy for the extraction of such calculi and for the treatment of other causes of obstructive jaundice over the past two years.