RSS-Feed abonnieren
DOI: 10.1055/s-2003-38137
Recurrent Pancreatitis as a Late Complication of Endoscopic Sphincterotomy for Common Bile Duct Stones: Diagnosis and Therapy
Publikationsverlauf
Submitted 16 March 2002
Accepted after Revision 26 July 2002
Publikationsdatum:
27. März 2003 (online)
![](https://www.thieme-connect.de/media/endoscopy/200304/lookinside/thumbnails/10.1055-s-2003-38137-1.jpg)
Although long-term complications of endoscopic sphincterotomy (ES) have often been reported, the possible effects of the procedure on the pancreatic duct orifice remain virtually unknown. Three women patients are described who developed attacks of recurrent pancreatitis at 2, 7, and 27 months after ES for bile duct stones. The attacks were apparently caused by a partial stenosis of the pancreatic orifice, arising from post-procedure fibrosis and scarring. The patients were evaluated and treated endoscopically. All three patients benefited from endoscopic therapy; two became symptom-free and one improved. Symptoms recurred in the three patients, after 26, 41, and 23 months. In one patient, re-stenosis was documented and repeat sphincterotomy resulted in complete relief of symptoms during the ensuing 5 months. In the remaining two patients, the symptoms were mild and no further intervention was needed. Concerning complications, one patient suffered a moderately severe pancreatitis without sequelae. Recurrent pancreatitis may emerge as a late complication after ES for common bile duct stones. It is probably causally related to stenosis of the pancreatic orifice brought about by fibrosis and scarring, which may exceptionally develop after the procedure. Endoscopic therapy should probably be considered in the first instance, but the optimal treatment for this condition remains to be determined.
References
- 1 Testoni P A, Tittobello A. Long-term efficacy of endoscopic papillo-sphincterotomy for common bile duct stones and benign papillary stenosis. Surg Endosc. 1991; 5 135-139
- 2 Hawes R H, Cotton P B, Vallon A G. Follow-up 6 - 11 years after duodenoscopic sphincterotomy for stones in patients with prior cholecystectomy. Gastroenterology. 1990; 98 1008-1012
- 3 Bergman J GHM, van der Mey S, Rauws E AJ. et al . Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointest Endosc. 1996; 44 643-649
- 4 Asbun H J, Rossi R L, Heiss F W, Shea J A. Acute relapsing pancreatitis as a complication of papillary stenosis after endoscopic sphincterotomy. Gastroenterology. 1993; 104 1814-1817
- 5 Cotton P B, Lehman G, Vennes J. et al . Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37 383-393
- 6 Rolny P. Diagnosis of pancreatic disease with special reference to the secretin-CCK test. Scand J Gastroenterol. 1980; 60 (Suppl.) 1-33
- 7 Rolny P, Ärleback A, Funch-Jensen P. et al . Paradoxical response of sphincter Oddi to intraveneous injection of cholecystokinin or ceruletide. Manometric findings and results of treatment in biliary dyskinesia. Gut. 1986; 27 1507-1511
- 8 Rolny P, Geenen J E, Hogan W J. Postcholecystectomy patients with “objective signs” of partial bile outflow obstruction: clinical characteristics, sphincter of Oddi manometry findings, and results of therapy. Gastrointest Endosc. 1993; 39 778-779
- 9 Rolny P. Endoscopic common bile duct stent placement as a predictor of outcome following endoscopic sphincterotomy in patients with suspected sphincter of Oddi dysfunction. Eur J Gastroenterol Hepatol. 1997; 9 467-471
- 10 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
- 11 Ell C, Rabenstein T, Schneider H T. et al . Safety and efficacy of pancreatic sphincterotomy in chronic pancreatitis. Gastrointest Endosc. 1998; 48 244-249
- 12 Kandekar S, DiSario J. Endoscopic therapy of the biliary and pancreatic duct orifices. Gastrointest Endosc. 2000; 52 500-505
- 13 Williamson R CN. Pancreatic sphincteroplasty: indications and outcome. Ann R Coll Surg Engl. 1988; 70 205-211
- 14 Okolo P I 3rd, Pasricha P J, Kalloo A N. What are the long-term results of endoscopic pancreatic sphincterotomy?. Gastrointest Endosc. 2000; 52 15-19
- 15 Elton E, Howel D A, Parsons W G. et al . Endoscopic pancreatic sphincterotomy: indications, outcome, and a safe stentless technique. Gastrointest Endosc. 1998; 47 240-249
P. Rolny, M.D., Ph.D.
Department of Medicine, Division of Gastroenterology and Hepatology, Sahlgrenska University Hospital-Östra
Gothenborg · Sweden
Fax: + 46-31-259254 ·
eMail: peter.rolny@vgregion.se