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Iatrogenic Ampullary Stenosis; History, Endoscopic Treatment and Outcome in a Series of 53 Patients

2006; Elsevier BV; Volume: 63; Issue: 5 Linguagem: Inglês

10.1016/j.gie.2006.03.746

1097-6779

Marielle C. Veldkamp, Erik A.J. Rauws, Paul Fockens, Marco J. Bruno,

Pediatric Hepatobiliary Diseases and Treatments

Background: Iatrogenic ampullary stenosis is a late complication of endoscopic interventions affecting the sphincter of Oddi. It consists of a heterogeneous group of stenotic lesions with a variable length and location along the intraduodenal portion of the sphincter complex and distal part of the common bile duct (CBD) and/or pancreatic duct (PD). This retrospective study aimed to evaluate the history, endoscopic treatment, and clinical outcome of iatrogenic ampullary stenosis. Methods: All patients diagnosed with and treated for iatrogenic ampullary stenosis in our hospital during the last 15 years were included. The patients' charts, endoscopic reports and X-rays were reviewed and scored. Long-term follow-up data was obtained through oral and written contact with patients, general physicians and specialists. Ampullary stenosis was distinguished in 2 types. Type I: limited to the intraduodenal portion of the sphincter complex (type I CBD or PD). Type II: all other types including extension of the stenosis into the CBD (type II CBD) or PD (type II PD). Results: Fifty-three patients were included (median age 56 years, 13 males, 40 females). The majority of patients had been treated for choledocholithiasis. There were 18 patients with type I CBD stenosis, 1 with type I PD stenosis, 31 with type II CBD stenosis, and 3 with type II PD stenosis. Treatment consisted of extension of the sphincterotomy opening in type I and included stent treatment in type II stenosis. During treatment complications occurred in 9 out of 53 patients (17%) including bleedings, (retroperitoneal) perforations or pancreatitis. All but 2 patients were managed non-surgically. No procedure related death occurred. Median follow-up after treatment was 2097 (240-4544) days. Conclusions: Iatrogenic ampullary stenosis occurred predominantly in females at various time intervals after multiple endoscopic interventions for biliary stone disease. Complication rate of endoscopic treatment for iatrogenic ampullary stenosis should not be discarded, but the majority could be managed non-surgically. Endoscopic treatment is successful in most patients and should be regarded as the management of choice. Surgery should be reserved for failures of endoscopic treatment. Tabled 1 Pre-stenosis Treatment and follow-up Type N No. of proced.\$ Complic. proced.# Time to stenosis \$ (days) No. of proced.\$ Complic. proced.∗ Success I CBD 18 2.0 (1-6) 3 (17%) 538 (28-5156) 1.5 (1-6) 2 (11%) 14 (78%) I PD 1 4.0 0 (0%) 48 6.0 1 (100%) 1 (100%) II CBD 31 3.0 (1-6) 5 (16%) 111 (24-1728) 4.0 (1-17) 6 (19%) 20 (65%) II PD 3 1.0 (1-4) 0 (0%) 312 (232-602) 4.0 (2-41) 0 (0%) 1 (33%) # significant bleeding with endoscopic, radiological or surgical treatment/ perforation \$ median (range). ∗ significant bleeding as in #/perforation/ pancreatitis Open table in a new tab # significant bleeding with endoscopic, radiological or surgical treatment/ perforation \$ median (range). ∗ significant bleeding as in #/perforation/ pancreatitis