Guest guest Posted August 22, 2007 Report Share Posted August 22, 2007 My son has had several endoscopic sphincterotomies during his many ERCPs to establish bile drainage. He has had recurring strictures in his common bile duct, had them balloon dilated several times then a series of stents were placved every 6 weeks or so for a year and several of those times he had huge cuts made with the sphincterotomies. I think the reasoning was to establish drainage that way instead of having to go with an external drain- but this is what his former doctor did so I don't really know why he did them- didn't tell us about them until after he did them. My son's former dr who did them has been criticized for doing more harm than good...but I don't really know why except that he is at much higher risk for ascending cholangitis now ?? I think ?? Any thoughts ? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2007 Report Share Posted August 26, 2007 Anyone here had a endoscopic sphincterotomy ? More than one to establish biliary drainage ? A hepatologist that my son was referred to thought he should get an external drain but that was never done- instead the former GI placed a series of stents for a year and did the sphincterotomies and his current doctors...well the last specialist he saw at least....long story...said that all the manipulations and sphincterotomies 'did more harm than good' ?!?!?!? > > My son has had several endoscopic sphincterotomies during his many > ERCPs to establish bile drainage. He has had recurring strictures in > his common bile duct, had them balloon dilated several times then a > series of stents were placved every 6 weeks or so for a year and > several of those times he had huge cuts made with the > sphincterotomies. I think the reasoning was to establish drainage that > way instead of having to go with an external drain- but this is what > his former doctor did so I don't really know why he did them- didn't > tell us about them until after he did them. > My son's former dr who did them has been criticized for doing more > harm than good...but I don't really know why except that he is at much > higher risk for ascending cholangitis now ?? I think ?? > Any thoughts ? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2007 Report Share Posted August 27, 2007 Hi, I did have an endoscopic sphincterotomy during one of my ERCPs. I do not understand how someone could have more than one though. As far as I understand the sphincter in question is at the end of the common bile duct where it drains into the duodenum. If I remember well the procedure is somewhat discouraged lately (because of infections), but in some cases it needs to be done. I would definatley prefer stents and sphincterotomy over external drains though (if they were performed by someone who does this all the time). You need someone with experience and good hands. Chaim Boermeester, Israel From: [mailto: ] On Behalf Of wildwildtrips Sent: Monday, August 27, 2007 06:13 To: Subject: Re: endoscopic spincterotomy Anyone here had a endoscopic sphincterotomy ? More than one to establish biliary drainage ? A hepatologist that my son was referred to thought he should get an external drain but that was never done- instead the former GI placed a series of stents for a year and did the sphincterotomies and his current doctors...well the last specialist he saw at least....long story...said that all the manipulations and sphincterotomies 'did more harm than good' ?!?!?!? > > My son has had several endoscopic sphincterotomies during his many > ERCPs to establish bile drainage. He has had recurring strictures in > his common bile duct, had them balloon dilated several times then a > series of stents were placved every 6 weeks or so for a year and > several of those times he had huge cuts made with the > sphincterotomies. I think the reasoning was to establish drainage that > way instead of having to go with an external drain- but this is what > his former doctor did so I don't really know why he did them- didn't > tell us about them until after he did them. > My son's former dr who did them has been criticized for doing more > harm than good...but I don't really know why except that he is at much > higher risk for ascending cholangitis now ?? I think ?? > Any thoughts ? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2007 Report Share Posted August 27, 2007 Thanks for your response. I agree that if it didn't 'do more harm than good' I am glad he had the sphincterotomies instead of the external drain. I didn't someone could need more than one either until my son's doctor said he had to do another one and made a HUGE cut the second time. I *think* the first one started closing up because of adhesions ???? The last MRCP he has showed tapering again so he may need another one ?? It's good to knopw that you had one and that you haven't had any problems as a result- am I understand correctly that it hasn't caused you problems ?? thanks again Lori lucky mom to wonderfully wild 11 year old triplets In , " Chaim Boermeester " wrote: > > Hi, > > > > I did have an endoscopic sphincterotomy during one of my ERCPs. I do not > understand how someone could have more than one though. As far as I > understand the sphincter in question is at the end of the common bile duct > where it drains into the duodenum. If I remember well the procedure is > somewhat discouraged lately (because of infections), but in some cases it > needs to be done. I would definatley prefer stents and sphincterotomy over > external drains though (if they were performed by someone who does this all > the time). You need someone with experience and good hands. > > > > Chaim Boermeester, Israel > > > > _____ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2007 Report Share Posted August 27, 2007 Our daughter had one and reacted very poorly to it, with increased pain and nausea and became very dehabilitated. They finally internalized the bag and put in a stent. She did well during that period but they removed it after 4 weeks because they were afraid it might clog and did a dilation instead which lasted for a short time. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2007 Report Share Posted August 28, 2007 Chaim Hi! I believe that in order to get the stents in to the duct - a sphincterctomy has to be performed. I was told that the sphinctor(spell?) is too narrow to allow the stents in. I may be wrong, but it wont be the first time :-) Thanks Re: endoscopic spincterotomy Anyone here had a endoscopic sphincterotomy ? More than one to establish biliary drainage ? A hepatologist that my son was referred to thought he should get an external drain but that was never done- instead the former GI placed a series of stents for a year and did the sphincterotomies and his current doctors...well the last specialist he saw at least....long story...said that all the manipulations and sphincterotomies 'did more harm than good' ?!?!?!? > > My son has had several endoscopic sphincterotomies during his many > ERCPs to establish bile drainage. He has had recurring strictures in > his common bile duct, had them balloon dilated several times then a > series of stents were placved every 6 weeks or so for a year and > several of those times he had huge cuts made with the > sphincterotomies. I think the reasoning was to establish drainage that > way instead of having to go with an external drain- but this is what > his former doctor did so I don't really know why he did them- didn't > tell us about them until after he did them. > My son's former dr who did them has been criticized for doing more > harm than good...but I don't really know why except that he is at much > higher risk for ascending cholangitis now ?? I think ?? > Any thoughts ? > Email and AIM finally together. You've gotta check out free AOL Mail! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2007 Report Share Posted August 28, 2007 Sphincterotomies are done for several reasons (not the least is improving access to the biliary tree). One is that it is less dangerous than dilatation of the sphincter. From http://www.medscape.com/viewarticle/493581 Nov. 11, 2004 — Balloon dilation of the sphincter of Oddi is associated with an increased risk of pancreatitis and death, compared with sphincterotomy for bile duct stone extraction, according to the results of a randomized, multicenter study published in the November issue of Gastroenterology. The investigators recommend avoiding this procedure. " Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is the standard of care for removal of bile duct stones, " write A. Disario, MD, from the University of Utah Health Sciences Center in Salt Lake City, and colleagues. " Balloon dilation of the sphincter of Oddi has been proposed to enlarge the orifice for stone extraction and avoid short-term and long-term morbidity of sphincterotomy.... The potential advantage of balloon dilation is that the biliary sphincter may regain some function and reduce the risk of long-term complications. " In a broad spectrum of clinical and academic practices, 117 patients were randomized to dilation and 120 to sphincterotomy. Clinical characteristics of the patients, technical aspects of the procedures, and experience of the endoscopists were similar in both groups, except that dilation patients were younger. Success rate of the procedure was 97.4% for dilation and 92.5% for sphincterotomy. Overall morbidity was 17.9% vs 3.3% (P < .001; difference, 14.6; 95% confidence interval [CI], 7 to 22.3), and severe morbidity was 6.8% vs 0% (P < .004; difference, 6.8; 95% CI, 2.3 to 11.4), respectively. There were two deaths (1.7%) from pancreatitis in the dilation group and none in the sphincterotomy group. Complications included pancreatitis The morbidity with dilation vs sphincterotomy is 6 times higher! My 2nd ERCP did have a sphincterotomy, the 1st and 3rd did not. I'm not sure why you would have more than one, unless scarring is an issue. It does not function after the first one. Arne ________________________________ My son has had several endoscopic sphincterotomies during his many ERCPs to establish bile drainage. He has had recurring strictures in his common bile duct, had them balloon dilated several times then a series of stents were placved every 6 weeks or so for a year and several of those times he had huge cuts made with the sphincterotomies... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2007 Report Share Posted August 28, 2007 Lori, I am mostly asymptomatic after the stents and sphincterotomy, and I hope it will stay like that for a while. Regards, Chaim From: [mailto: ] On Behalf Of wildwildtrips Sent: Tuesday, August 28, 2007 04:29 To: Subject: Re: endoscopic spincterotomy Thanks for your response. I agree that if it didn't 'do more harm than good' I am glad he had the sphincterotomies instead of the external drain. I didn't someone could need more than one either until my son's doctor said he had to do another one and made a HUGE cut the second time. I *think* the first one started closing up because of adhesions ???? The last MRCP he has showed tapering again so he may need another one ?? It's good to knopw that you had one and that you haven't had any problems as a result- am I understand correctly that it hasn't caused you problems ?? thanks again Lori lucky mom to wonderfully wild 11 year old triplets In , " Chaim Boermeester " wrote: > > Hi, > > > > I did have an endoscopic sphincterotomy during one of my ERCPs. I do not > understand how someone could have more than one though. As far as I > understand the sphincter in question is at the end of the common bile duct > where it drains into the duodenum. If I remember well the procedure is > somewhat discouraged lately (because of infections), but in some cases it > needs to be done. I would definatley prefer stents and sphincterotomy over > external drains though (if they were performed by someone who does this all > the time). You need someone with experience and good hands. > > > > Chaim Boermeester, Israel > > > > _____ > > Quote Link to comment Share on other sites More sharing options...
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