Endoscopic Papillotomy:  A Plea for Rational Restraint

Division of Oddi's sphincter may be accomplished under direct vision in the operating room or by electrocautery via the endoscope. Regardless of the technique employed, the procedure is associated with recognized complications, some of which result in death. The limitations and complications of sphincteroplasty are well known to the general surgeon. Endoscopists are beginning to appreciate the reality of this morbidity and mortality. We have recently had experience with two fatal and one nonfatal complications after endoscopic papillotomy. The reason for this procedure in two patients was "stenosis" of Vater's ampulla, and in the third patient calculi were present in both the common duct and the gallbladder. The deaths were due to pancreatitis in one patient and cholangitis in the other. The nonfatal complication was a duodenal perforation at Vater's ampulla. With any newtherapeutic procedure, excessive enthusiasm and the lack of proper guidelines may result in its overuse. A case