In 1974, Professors Meinhard Classen (Germany) and Keiichi Kawai (Japan) independently published their pioneering experience of endoscopic biliary sphincterotomy (EBS).^1,2 This bold innovative work was performed in the face of considerable antagonism from the surgical community, which considered that endoscopists had no business in the biliary tree, traditionally regarded as surgical “turf”. In the 30 years since, countless thousands of patients have benefited from EBS, being spared major surgical and radiological procedures. That an electrosurgical incision of a centimetre or less can have such beneficial effect is testament to the ingenuity of the pioneer endoscopists and their partners in industry. EBS is now an everyday event in endoscopy units around the world, the great majority being completed safely and achieving the desired goal. Indeed, we tend to take EBS for granted. The recent National Institutes of Health Consensus Conference Panel deemed endoscopic retrograde cholangiopancreatography (ERCP) and EBS to be essential tools in the management of patients with acute cholangitis, pancreatitis, and choledocholithiasis.³ EBS has been shown to be safe and effective in experienced hands but it is undoubtedly associated with both short and long term complications.⁴

Recurrent bile duct stone formation is not uncommon following EBS. The literature suggests an incidence ranging from 4 % to 24%.^5,6 Further ERCP with extension of the previous sphincterotomy is often the treatment of choice in patients with recurrent choledocholithiasis but little is know of the long term results and complications of this treatment. In this issue of …