2010 Volume 24 Issue 1 Pages 82-86
Endoscopic sphincterotomy (EST) affects the function of the sphincter of Oddi and, eventually, the biliary tract. Manometry demonstrates the absence of the basal pressure of the sphincter of Oddi but partial recovery of sphincter contractions later, after EST. EST decreases the fasting volume of the gallbladder and increases the contraction ability for a long period. EST often causes duodenobiliary reflux and bacterial contamination of the bile ducts, but rarely induces biliary infection. Although EST causes transient pancreatobiliary reflux, the reflux is abolished within one year after EST. On the other hand, endoscopic papillary balloon dilation (EPBD) transiently improves papillary functions and gallbladder motility. EPBD does not appear to induce severe duodenobiliary reflux.
The incidence of bile duct stone recurrence of 5.8-24% after EST is comparable to the reported incidence of 7.1-13.5% after EPBD. The reported incidence of cholangitis after EST (5.8-9.7%) is lower than that after EPBD (0.9-2.2%). The incidence of acute cholecystitis after EST is reportedly 10-15% in patients with gallbladder stones but approaches 0% in those without gallbladder stones. The reported incidence of acute cholecystitis after EPBD is significantly lower than that after EPBD (2.2-3.4%). The reported incidence of carcinoma development in the biliary tree after EST or EPBD is extremely low (0-0.6% after ES and 0-0.6% after EPBD). EST or EPBD is unlikely to increase the risk of development of biliary tract carcinoma.
