title: Endoscopic papillotomy in biliary tract pain and fluctuating cholestasis with common bile duct dilatation and small gallbladder stones.
abstract: In patients suspected of having functional disorders of the papilla it is often difficult to establish the indications whether or not to perform endoscopic papillotomy (EP). We report on thirty-two consecutive patients referred for endoscopic retrograde cholangiopancreatography who all had longstanding biliary tract pain and episodes of liver enzyme elevation indicating cholestasis. Further features were: 1) a dilated common bile duct (CBD) after cholecystectomy (n = 11) or 2) a dilated CBD without or with larger (greater than cystic duct diameter) gallbladder stones (n = 6) or 3) multiple small gallbladder stones, with a normal or dilated CBD, in patients with signs of acute gallstone pancreatitis or in whom elective cholecystectomy was not indicated (n = 15). No CBD stones, organic obstruction or other disorders were found in these patients. Without further diagnostic procedures, EP was routinely performed. The laboratory (up to 3 months) and clinical findings (2 to 4 years follow up) showed improvement in all patients undergoing EP. We conclude that immediate EP appears justified in these selected patients.
authors.affiliation: Department of Diagnostic Radiology, University Hospital, Rotterdam-Dijkzigt, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Boender
authors.forename: M
authors.initials: M
authors.lastname: van Blankenstein
authors.forename: G A
authors.initials: GA
authors.lastname: Nix
authors.forename: J H
authors.initials: JH
authors.lastname: Wilson
authors.forename: J
authors.initials: J
authors.lastname: Dees
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000601:surgery*; D002779:Cholestasis / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000601:surgery*; D004108:Dilatation, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care; D016717:Sphincterotomy, Endoscopic