Background and Study Aims: In recent years, interest in endoscopic therapy techniques for pancreatic diseases has been constantly increasing. The aim of the present study was to assess the technical success, technique, and complications of endoscopic pancreatic sphincterotomy (EPS) in patients with chronic pancreatitis.
Patients and Methods: A total of 171 patients with chronic pancreatitis and abdominal complaints were identified in whom at least one attempt at EPS was carried out. During the procedure, sphincterotomy was carried out using a guide-wire sphincterotome or a needle-knife papillotome. Patients were followed up after EPS for at least 24 h, including clinical symptoms and laboratory data (pancreatic enzymes and hemoglobin/hematocrit).
Results: EPS was performed in 167 of the 171 patients (technical success rate: 97.7 %). In 24 patients (14 %), a precut technique was necessary using a needle-knife sphincterotome. Sphincterotomy-related complications were observed in seven of the 171 patients (4.1 %), including three cases of bleeding, three patients with mild pancreatitis, and one with retroduodenal perforation. All complications were managed medically. There was no treatment-related mortality.
Conclusions: Endoscopic sphincterotomy of the pancreatic duct in patients with chronic pancreatitis is a fairly safe procedure with a high technical success rate.
References
-
1
Classen M, Demling L.
Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus.
Dtsch Med Wochenschr.
1974;
99
496-498
-
2
Kawai K, Akasaka Y, Murakami K. et al .
Endoscopic sphincterotomy of the ampulla of Vater.
Gastrointest Endosc.
1974;
20
148-151
-
3
Binmoeller K F, Seifert H, Walter A, Soehendra N.
Transpapillary and transmural drainage of pancreatic pseudocysts.
Gastrointest Endosc.
1995;
42
219-224
-
4
Cremer M, Devière J, Delhaye M. et al .
Stenting in severe chronic pancreatitis: results of medium-term follow-up in seventy-six patients.
Bildgebung.
1992;
59 (Suppl 1)
20-24
-
5
Smits M E, Rauws E AJ, Tytgat G NJ. et al .
Endoscopic treatment of pancreatic stones in patients with chronic pancreatitis.
Gastrointest Endosc.
1996;
43
556-560
-
6
Jakobs R, Riemann J F.
The role of endoscopy in acute recurrent and chronic pancreatitis and pancreatic cancer.
Gastroenterol Clin North Am.
1999;
28
783-800
-
7
Elton E, Howell D A, Parsons W G. et al .
Endoscopic pancreatic sphincterotomy: indications, outcome and a safe stentless technique.
Gastrointest Endosc.
1998;
47
240-249
-
8
Fuji T, Amano H, Harima K. et al .
Pancreatic sphincterotomy and pancreatic endoprostheses.
Endoscopy.
1985;
17
69-72
-
9
Sarner M, Cotton P B.
Classification of pancreatitis.
Gut.
1984;
25
756-759
-
10
Ell C, Rabenstein T, Schneider H T. et al .
Safety and efficacy of pancreatic sphincterotomy in chronic pancreatitis.
Gastrointest Endosc.
1998;
48
244-249
-
11
Cotton P B, Lehman G, Vennes J A.
Endoscopic sphincterotomy complications and their management: an attempt at consensus.
Gastrointest Endosc.
1991;
37
383-391
-
12
Fuji T, Amano H, Ohmura R. et al .
Endoscopic pancreatic sphincterotomy: technique and evaluation.
Endoscopy.
1989;
21
27-30
-
13
Kozarek R A, Ball T J, Patterson D J. et al .
Endoscopic pancreatic duct sphincterotomy: indications, technique and analysis of results.
Gastrointest Endosc.
1994;
40
592-598
-
14
Watanapa P, Williamson R CN.
Pancreatic sphincterotomy and sphincteroplasty.
Gut.
1992;
33
865-867
-
15
Okolo P I, Pasricha P J, Kalloo A N.
What are the long-term results of endoscopic pancreatic sphincterotomy?.
Gastrointest Endosc.
2000;
52
15-19
-
16
Freeman M L, Nelson D B, Sherman S. et al .
Complications of endoscopic biliary sphincterotomy.
N Engl J Med.
1996;
335
908-918
-
17
Freeman M L.
Complications of endoscopic biliary sphincterotomy: a review.
Endoscopy.
1997;
29
288-297
-
18
Rabenstein T, Schneider H T, Hahn E G, Ell C.
25 years of endoscopic sphincterotomy in Erlangen: assessment of the experience in 3498 patients.
Endoscopy.
1998;
30
A 194-201
-
19
Rabenstein T, Schneider H T, Bulling D. et al .
Analysis of the risk factors associated with endoscopic sphincterotomy techniques: preliminary results of a prospective study, with emphasis on the reduced risk of acute pancreatitis with low-dose anticoagulation treatment.
Endoscopy.
2001;
32
10-19
R. Jakobs, M.D.
Dept. of Medicine C (Gastroenterology) · Klinikum der Stadt Ludwigshafen ·
Bremserstrasse 79 · 67063 Ludwigshafen · Germany
Fax: + 49-621-503 4114
Email: MedCLu@t-online.de
