Long-Term Biliary Endoscopic Sphincterotomy Restenosis: Incidence, Endoscopic Management, and Complications of Retreatment

Farshad ELMI; William B SILVERMAN

doi:10.1007/s10620-009-0957-3

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Long-Term Biliary Endoscopic Sphincterotomy Restenosis: Incidence, Endoscopic Management, and Complications of Retreatment

Journal article

Peer reviewed

Long-Term Biliary Endoscopic Sphincterotomy Restenosis: Incidence, Endoscopic Management, and Complications of Retreatment

Farshad ELMI and William B SILVERMAN

Digestive diseases and sciences, Vol.55(7), pp.2102-2107

2010

DOI: 10.1007/s10620-009-0957-3

PMID: 19731023

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Abstract

Background: Ampullary restenosis is a late complication of biliary endoscopic sphincterotomy. Long-term data are limited regarding both the rate of restenosis and complications resulting from repeat therapy. Aims: To determine the incidence of post sphincterotomy restenosis and the effectiveness of endoscopic therapy in the management of this entity. Methods: A retrospective review of medical charts and the endoscopic retrograde cholangiopancreatography (ERCP) database to identify patients with ERCP and biliary endoscopic sphincterotomy during the period 1998-2002 at the University of Iowa Hospitals was conducted. All subjects were contacted by phone and asked about the recurrence of their pancreatobiliary symptoms after the first ERCP and whether they sought any medical treatment for these symptoms. The primary outcome was restenosis of the sphincterotomy site and the secondary outcome was complications of endoscopic treatment of sphincterotomy restenosis. Results: A total of 202 patients underwent ERCP and biliary endoscopic sphincterotomy on an intact major papilla. Of these, n = 80 patients (54.7 +/- 19 years of age, 76% female) consented and enrolled in the study. Among these, n = 13 (16%) developed ampullary restenosis in 1-62 (median 16) months after the index ERCP. These 13 patients underwent a total of 24 ERCPs (range 1-4 for each patient) for repeat biliary sphincterotomy and biliary stenting, if needed. Repeat biliary endoscopic sphincterotomy was successful in 12/13 (92%) patients. Complications of repeat biliary endoscopic sphincterotomy were seen in three patients: mild pancreatitis (n = 1), severe bleeding (n = 1), and severe duodenal perforation (n = 1). Conclusions: Long-term restenosis is an important sequella of biliary endoscopic sphincterotomy. Repeat biliary endoscopic sphincterotomy is an effective treatment modality, but complications are not negligible.

Digestive System

Fundamental and applied biological sciences. Psychology

Feeding. Feeding behavior

Radiodiagnosis. Nmr imagery. Nmr spectrometry

Vertebrates: anatomy and physiology, studies on body, several organs or systems

Investigative techniques, diagnostic techniques (general aspects)

Biological and medical sciences

Medical sciences

Details

Title: Subtitle: Long-Term Biliary Endoscopic Sphincterotomy Restenosis: Incidence, Endoscopic Management, and Complications of Retreatment
Creators: Farshad ELMI - Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, 4544 JCP, Iowa City, IA 52242, United States
William B SILVERMAN - Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, 4553A JCP, University of Iowa Hospitals, Iowa City, IA 52242, United States
Resource Type: Journal article
Publication Details: Digestive diseases and sciences, Vol.55(7), pp.2102-2107
Publisher: Springer
DOI: 10.1007/s10620-009-0957-3
PMID: 19731023
ISSN: 0163-2116
eISSN: 1573-2568
Language: English
Date published: 2010
Academic Unit: Gastroenterology and Hepatology; Internal Medicine
Record Identifier: 9984094327102771

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