The role of endoscopic biliary sphincterotomy for the treatment of type 1 biliary dysfunction (papillary stenosis) with or without biliary stones

Sugawa, Choichi; Brown, Kristian L.; Matsubara, Toshiki; Bachusz, Rebecca C; Ono, Hiromi; Chino, Akiko; Yamasaki, Takuji; Lucas, Charles E.

doi:10.1016/j.amjsurg.2013.04.007

Cited by 8 publications

(5 citation statements)

References 30 publications

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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.…”

Section: Discussionmentioning

confidence: 99%

Management of Obscurely Dilated Common Bile Duct with Normal Liver Function Tests: A Pragmatic Approach

et al. 2021

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Objective Dilated common bile duct (CBD) (8–15 mm) with normal liver function tests is seen not infrequently, while management of such patients is ambiguous. We propose a treatment algorithm for this cohort of patients after observing them over a period of 8 years. Methods Seventy‐eight such patients were managed from 2009 to 2017 and categorized as: Group A—dilated CBD with post‐cholecystectomy status (n = 15); B—dilated CBD with cholelithiasis (n = 34); C—dilated CBD without cholelithiasis (n = 16); D—dilated CBD with no cause identified and underwent CBD excision (n = 13). Causes for CBD dilatation were evaluated. The outcome of patients in Group B + C without any cause (n = 33) was compared with Group D. Result Median age, CBD diameter, bilirubin and alkaline phosphatase were 51 years (13–79), 10 mm (8–20), 0.6 mg/dl (0.2–2.5) and 126 IU (60–214), respectively. Group‐A patients who did not manifest any cause of CBD dilatation were managed conservatively. The aetiology was identified in 17/50 patients in Group B & C [acute pancreatitis (n = 6), passed CBD calculi (n = 3), perivaterian diverticulum (n = 3), viral aetiology (n = 4) and tumour (n‐1)]. In Group‐C, 7 patients with no obvious cause underwent endoscopic sphincterotomy, pancreatoduodenectomy (n = 1), and the rest were managed conservatively (n = 8). There was no significant difference in the complication between Group B + C (without any cause) and Group D (3/33 vs. 1/13; p = 0.58) at a median follow‐up of 72 months (30–90). Conclusion Dilated CBD with normal LFT's without apparent cause is mostly benign and of no consequence. Excision of the CBD is not required for most of these patients.

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Section: Discussionmentioning

confidence: 99%

Management of Obscurely Dilated Common Bile Duct with Normal Liver Function Tests: A Pragmatic Approach

et al. 2021

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“…Apart from gastrointestinal diseases, liver pathology, such as chronic hepatitis, hepatolithiasis, fatty liver and cirrhosis, are also related and misinterpreted as a possible PCS. An anatomical structure relevant to the development of PCS is the Sphincter of Oddi dysfunction, a benign obstructive disorder of the ampullary sphincter (SOD) [27,28]. SOD is a possible aetiology of persistent or recurrent colic pain either before or after cholecystectomy as well as idiopathic pancreatitis [29].…”

Section: Scenario Of Pcs Not Related To Surgerymentioning

confidence: 99%

“…SOD is a possible aetiology of persistent or recurrent colic pain either before or after cholecystectomy as well as idiopathic pancreatitis [29]. SOD can be caused either by stenosis resulting from fibrosis and/or inflammation or by dyskinesia from intermittent obstruction due to sphincter muscle spasm [27,30]. There are also other less frequent diseases that can be associated with PCS symptomatology such as cardiac disorders, autoimmune diseases and nerve system disorders [31].…”

Section: Scenario Of Pcs Not Related To Surgerymentioning

confidence: 99%

“…In 1947, Womack suggested resection of scar and nerve tissue around the cystic duct stump for the treatment of PCS [10]. Other researchers suggested that resection of the cystic duct remnant [13], sphincter dilation, sphincterotomy [27], sphincteroplasty [55], biliary bypass [56], common bile duct exploration, and stone removal can achieve relief in the symptoms of PCS.…”

Section: Trea Tmentmentioning

confidence: 99%

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Enriched view of postcholecystectomy syndrome: Nowadays and in former times

et al. 2015

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Aim-Background:The aim of the present review is to evidence the differences in the nature of PCS between open and laparoscopic cholecystectomy and also to examine how this condition has evolved over the years. In 5 to 40% of patients with cholelithiasis, regardless of the type of surgery, the symptoms persist postoperatively, leading to the development of the so-called postcholecystectomy syndrome (PCS). The time of the onset of symptoms ranges from 2 days to 25 years after cholecystectomy.Methods: A total number of 926 articles were found as a literature reference pool. We searched English language articles published in Medline, Scopus and google scholar. Only review articles were retrieved because no comparative studies or prospective clinical trials were found to provide statistically significant conclusions. The final group of articles was reviewed, and a total of 57 papers were used for the present review. Results:The literature is conflicting as concerns the pathophysiology and the aetiology of PCS. Regardless of the type of surgery, it seems that PCS is correlated to age and sex. The prevailing view is that retained or recurrent gallstones, gallbladder remnants and Sphincter of Oddi dysfunction are the primary causes. Moreover, systemic diseases of the gastrointestinal (GI) tract, cardiac disorders, autoimmune diseases, nervous system and psychological distress can mimic PCS symptoms. Nonetheless, there are many available techniques regarding diagnosis and treatment. Nowadays, the majority of researchers endorse ERCP as the gold standard for diagnosis and treatment. Conclusion:The preoperative meticulous investigation of patients with cholelithiasis is mandatory in order to identify coexisting disorders related to PCS, achieve a better therapeutic approach, and principally reduce PCS incidence.

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“…4 Many of these biliary causes of PCS, such as stones, strictures, and leaks, can be treated with endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy; treatment of type 2 and 3 SOD with sphincterotomy is controversial. 5 The diagnosis of SOD is also not straightforward. Biliary manometry is the only quantifiable method for diagnosis of SOD and carries its own risks.…”

Section: Introductionmentioning

confidence: 99%

Long-term Follow-up of Patients Undergoing Endoscopic Intervention for Abdominal Pain with Minimal Biliary Ductal Dilation, Stone Disease, or Malignancy

Mortensen

Bhutiani

Brown

et al. 2021

The American Surgeon™

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Background Safety and efficacy of endoscopic methods in management of biliary colic after cholecystectomy in patients with minimal biliary ductal dilation and no evidence of biliary stones or malignancy have not been clearly demonstrated. This study aimed to assess the efficacy of endoscopic management of such patients. Methods The University of Louisville database was queried for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for colicky abdominal pain between 1996 and 2016 who had a common bile duct (CBD) diameter of ≤12 mm. All patients had undergone prior cholecystectomy and were free of malignancy. Demographic, serologic, procedural, and outcome variables were assessed. Results A total of 35 patients underwent a total of 99 ERCPs. Median CBD diameter was 10 (range 4-12) mm. A total of 31 patients (89%) underwent sphincterotomy, 28 (80%) underwent stent placement, and 5 (14%) underwent balloon dilation. The median number of ERCPs performed was 2 (range 1-10). Three of the 35 patients (9%) developed post-ERCP pancreatitis at some point during their treatment. At last follow-up since initial ERCP (median 16 months, range 2.4-184 months), 12 (34%) patients endorsed abdominal pain and 11 (31%) reported experiencing nausea. Conclusion For select patients with abdominal pain in the setting of minimal CBD dilation and no evidence of stone disease or malignancy, ERCP can safely and effectively be used to manage symptoms. While patients may require multiple interventions, they can derive long-term relief from these procedures.

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The role of endoscopic biliary sphincterotomy for the treatment of type 1 biliary dysfunction (papillary stenosis) with or without biliary stones

Cited by 8 publications

References 30 publications

Management of Obscurely Dilated Common Bile Duct with Normal Liver Function Tests: A Pragmatic Approach

Management of Obscurely Dilated Common Bile Duct with Normal Liver Function Tests: A Pragmatic Approach

Enriched view of postcholecystectomy syndrome: Nowadays and in former times

Long-term Follow-up of Patients Undergoing Endoscopic Intervention for Abdominal Pain with Minimal Biliary Ductal Dilation, Stone Disease, or Malignancy

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