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Volume 8 Journal of Gastrointestinal & Digestive System
ISSN: 2161-069X Gastro Congress 2018
August 20-21, 2018
August 20-21, 2018 | Rome, Italy
13th Euro-Global
Gastroenterology Conference
The effectiveness of the new method of radial sphincterotomy
Kenan Yusif Zade
Military Hospital of State Border Service, Azerbaijan
Introduction: In choledocholithiasis subject to the size of the stone and the anatomical structure of the papilla the size of the
cross-section in sphincterotomy may vary. Sufficiently large incision in sphincterotomy leads to the increase in the incidence
of complications after ERCP as perforation, cholangitis, and pancreatitis.
Materials &Methodology:We performed 77 ERCP (endoscopic retrograde cholangio-pancreatography) operations in patients
with a diagnosis of "choledocholithiasis". In the first group (59 patients) we performed standard sphincterotomy incision in 11,
12 or 13 o’clock direction, in the second group (18 patients) - "radial" sphincterotomy. The technique of "radial" sphincterotomy
we developed allows to make several lateral incisions in 11, 12 and 13 o’clock directions. Thus, the main incision can be made
up to transverse fold, and other radial incisions shall be made below the transverse folds, without going beyond the boundaries
of the assumed course of intramural choledoch. Thus, the complete cross section of the incision with additional insections at
the radial sphincterotomy becomes 1.5 times larger than the main incision in standard sphincterotomy.
Results: In the first group periampullary diverticulum was 16.7%, while in the second group - 47.4%. Number of stones in the
first group – 2.25±0.49, in the second – 2.22±0.32, sizes of the stones – 10.07±4.93 and 19.01±3.31 mm, respectively. In the first
group, complications occurred in 3 (5.08%) patients: in 1 of them - post-ERCP pancreatitis, in 2 - bleeding during the session.
In the second group, only 1 (5.5%) patient had pancreatitis and other early and late complications. In the first group with 3
patients - the common bile duct stone removal was achieved in two sessions with a few day interval, the remaining - in a single
session. In the 2nd group, all patients required only one session. No cases of mortality occurred in any of the groups.
Conclusions: Radial sphincterotomy technique was substantiated from anatomical and mathematical aspects. The proposed
technique is a safe way to increase the area of dissected papillae ensuring efficient removal of large stones through such incision.
Recent Publications:
1. Yusif Zade K R (2014) Rationale for the effectiveness of the new method of radial sphincterotomy in the obstruction
of extrahepatic biliary tract. Kazan Medical Journal. 956(6):816-821.
2. Zhang W J et al. (2015) Treatment of gallbladder stone with common bile duct stones in the laparoscopic era. BMC
Surgery. 15:7.
3. Trikudanathan G, Navaneethan U and Parsi M A (2013) Endoscopic management of difficult common bile duct
stones. World J. Gastroenterol. 19(2):165-173.
4. Heo J H et al. Endoscopic sphincterotomy plus large-balloon dilation versus endoscopic sphincterotomy for removal
of bile-duct stones. Gastrointest Endosc. 66(4):720-726.
Biography
Kenan Yusif Zade holds an MD and PhD Degree from Azerbaijan Medical University, Azerbaijan. He also holds an MBA Degree from Maastricht School of
Management, The Netherlands and EMBA Degree from ADA University, Azerbaijan. He is the Head of Military Hospital of State Border Service, Azerbaijan. His
professional fields are general surgery, gastroenterology and invasive endoscopy. In 2007, he founded an Association of Turkish-Azerbaijani Endoscopic Surgeons.
He is also the President-Elect (2017-2019) of Ambroise Paré International Military Surgery Forum (APIMSF). His second education is Business Management.
Kenan Yusif Zade, J Gastrointest Dig Syst 2018, Volume 8
DOI: 10.4172/2161-069X-C5-076