Endoscopic sphincterotomy in acute cholangitis due to choledocholithiasis.
The efficacy of endoscopic sphincterotomy in the treatment of acute cholangitis caused by choledocholithiasis was evaluated in a consecutive series of 30 patients. Twenty-five patients (83%) were satisfactorily treated, leading to a normalization of serum alkaline phosphatase, bilirubin and temperature. The procedure was unsuccessful in 4 patients because of large stones. All 4 were submitted to surgery. None of the patients in whom sphincterotomy had been performed had short-term complications. Follow-up with a mean observation time of 22 months showed that 84% of the patients, remained completely symptom-free. Our results are in agreement with those reported in the literature. It is concluded that treatment with instrumental extraction through endoscopic sphincterotomy is simple and fast, and that it should be considered the treatment of choice in the majority of patients with acute cholangitis. For these patients, relief of the biliary obstruction and normalization of the increased intrabiliary pressure remain an essential prerequisite for a favourable outcome.