Endoscopic sphincterotomy in patients with stenosis of ampulla of Vater: three-year follow-up of exocrine pancreatic function and clinical symptoms.
OBJECTIVE
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), follow-up 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 microg/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.


CONCLUSIONS
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.
Ewald
Nils
N
Third Medical Department and Policlinic, University Hospital Giessen and Marburg, Giessen Site, D-35392 Giessen, Germany. nils.ewald@innere.med.uni-giessen.de
Marzeion
Axel Michael
AM
Bretzel
Reinhard Georg
RG
Kloer
Hans Ulrich
HU
Hardt
Philip Daniel
PD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D000681:Amylases / Q000097:blood; D003137:Common Bile Duct Diseases / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D046790:Pancreas, Exocrine / Q000502:physiology*; D010196:Pancreatic Elastase / Q000378:metabolism; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome
D008049:Lipase; D000681:Amylases; D010196:Pancreatic Elastase