THE MACRODILATATION OF THE SPHINCTER OF ODDI OR SPHINCTEROPLASTY IN THE TREATMENT OF LARGE STONES OF THE MAIN BILE DUCT ABOUT A MOROCCAN POPULATION

Aims Sphincteroplasty is a large dilatation of the papilla which completes an endoscopic sphincterotomy . The aim of this work is to evaluate the results and complications of sphincteroplasty and associated factors.

Methods Retrospective study: January 2008- March 2019. 58 patients with macrocalculations of the main bile duct. The success: absence of residual calculation at the end of the procedure. Statistical analysis was by the Spss20. The associated factors studied: age, sex, and diameter of the main bile duct, number of stones, presence of cholangitis, bile duct size disparity, and the concept of anterior sphincterotomy.

Results Age: 63.5 ± 12 years.sex ratio H/F: 0.7 .57.9% of the patients had multiple stones (≥2), 29.6% had sphincteroplasty 13.6% of patients had an associated endoscopic sphincterotomy, and in 11.3% there was a difference in caliber between the calculation and the diameter of the bile duct downstream.The clinical presentation: cholangitis in 9 patients; dissociated biliary symptoms suggestive of lithiasis migration in 32 patients while 16 patients showed no symptoms. The average number of stones found was 1.86 ± 0.8 per patient with extremes ranging from 1 to 10. The average diameter of the bile duct 18 ± 4 mm, that of the stones was 18 ± mm, and that of Macrodilating balloon was 16.9 ± 1.5 mm with extremes ranging from 14 to 20 mm.The success rate: 91.6% . Extraction was not possible in 6 patients with macrocalculations with an average diameter of 19 ± 2 mm(plastic biliary prosthesis for 2 patients). The complication rate:6.8%(minimal bleeding curbed by pneumatic compression).

Conclusions Sphincteroplasty is an effective method at the cost of a low morbidity for the endoscopic extraction of macrocalculations of the bile duct. success rate is 91.6% and immediate complications are rare. No factors studied seem to be associated with the failure or success of this technique