Endoscopic sphincterotomy in patients with stenosis of ampulla of Vater: Three-year follow-up of exocrine pancreatic function and clinical symptoms

Abstract

AIM: To investigate retrospectively the long-term effect of endoscopic sphincterotomy (ES) including exocrine pancreatic function in patients with stenosis of ampulla of Vater. METHODS:After diagnostic endoscopic retrograde cholangiopancreatography (ERCP) and ES because of stenosis of the ampulla of Vater (SOD Type Ⅰ), followup examinations were performed in 60 patients (mean follow-up time 37.7 mo). Patients were asked about clinical signs and symptoms at present and before intervention using a standard questionnaire. Before and after ES exocrine pancreatic function was assessed by determination of immunoreactive fecal elastase 1. Serum enzymes indicating cholestasis as well as serum lipase and amylase were measured. RESULTS:Eighty percent of patients reported an improvement in their general condition after ES. The fecal elastase 1 concentrations (FEC) in all patients increased significantly after ES. This effect was even more marked in patients with pathologically low concentrations (< 200 μg/g) of fecal elastase prior to ES. The levels of serum lipase and amylase as well as serum alcaline phosphatase (AP) and gamma-glutamyltranspeptidase (GGT) decreased significantly after ES. CONCLUSION:The results of this study demonstrate that patients with stenosis of the ampulla of Vater can be successfully treated with endoscopic sphincterotomy. The positive effect is not only indicated by sustained improvement of clinical symptoms and cholestasis but also by improvement of exocrine pancreatic function.© 2007 The WJG Press. All rights reserved.

Cholangiolytic Changes in Statin-Induced Liver Injury

“…Following sphincterotomy, the bilirubin level normalized to the degree expected [23], but the liver enzymes continued elevated [24], with a mixed pattern. This, plus the absence of cholestasis-related changes in the lobular parenchyma and the distribution of bile ducts and cholangioles in the portal tracts (i.e., not predominantly at the edges of the portal tracts), indicated that something more than biliary obstruction was present in this patient, and nonbiliary causes were considered.…”

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“…Further, those who responded to it were continued on conservative management and regular follow‐up. The role of EST has shown to be effective in the context of SOD and papillary stenosis [18, 19]. However, its empiric role to decompress the biliary pressure needs to be evaluated in patients of ODC.…”

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