Biliary endoscopic sphincterotomy

Biliary Endoscopic Sphincterotomy

Biliary endoscopic sphincterotomy (BES) is a medical procedure performed to treat disorders of the bile duct, such as choledocholithiasis (bile duct stones), sphincter of Oddi dysfunction, and certain types of biliary strictures. This procedure is typically performed during an ERCP, which is a diagnostic and therapeutic procedure used to examine the bile ducts, pancreatic duct, and gallbladder.

Procedure

Biliary endoscopic sphincterotomy involves the use of an endoscope, which is a flexible tube with a camera and light at the end, to access the duodenum where the bile duct opens into the small intestine. The procedure is performed as follows:

1. Preparation: The patient is sedated, and the endoscope is inserted through the mouth, passing through the esophagus and stomach to reach the duodenum.

2. Cannulation: The endoscopist identifies the major duodenal papilla, where the bile duct opens into the duodenum, and inserts a cannula into the bile duct.

3. Sphincterotomy: A sphincterotome, which is a specialized cutting instrument, is passed through the endoscope. An electrosurgical current is used to make an incision in the sphincter of Oddi, the muscle that controls the flow of bile and pancreatic juice into the duodenum.

4. Stone Extraction or Stent Placement: If stones are present, they can be removed using a balloon or basket. In cases of strictures, a stent may be placed to keep the duct open.

5. Completion: The endoscope is withdrawn, and the patient is monitored for any complications.

Indications

Biliary endoscopic sphincterotomy is indicated for:

- Choledocholithiasis: Removal of stones from the bile duct. - Sphincter of Oddi Dysfunction: Relieving obstruction caused by dysfunction of the sphincter. - Biliary Strictures: Dilating or stenting strictures to restore bile flow. - Biliary Leaks: Managing leaks from the bile duct, often post-surgery.

Complications

While generally safe, BES can have complications, including:

- Pancreatitis: Inflammation of the pancreas, occurring in 3-10% of cases. - Bleeding: Due to the incision made in the sphincter. - Perforation: Rare but serious, involving a tear in the duodenum or bile duct. - Infection: Such as cholangitis, an infection of the bile duct.

Recovery and Follow-up

Patients typically recover quickly from BES, with most being discharged the same day or the next. Follow-up care may include:

- Monitoring for signs of complications, such as abdominal pain or fever. - Dietary modifications to aid digestion. - Additional imaging or procedures if stones or strictures recur.

Also see

- Endoscopic Retrograde Cholangiopancreatography - Choledocholithiasis - Sphincter of Oddi Dysfunction - Biliary Stricture - Cholangitis