Iatrogenic ampullary stenosis: history, endoscopic management, and outcome in a series of 49 patients.
BACKGROUND
Iatrogenic ampullary stenosis is a late complication of endoscopic interventions that affects the sphincter of Oddi.


OBJECTIVE
To evaluate the history, endoscopic treatment, and outcome of iatrogenic ampullary stenosis.


METHODS
Patients' charts, endoscopic reports, and x-ray films were reviewed and scored. Long-term follow-up data were obtained by means of contact with attending specialists, general physicians, and patients. Ampullary stenoses were distinguished by 2 types: type I, limited to the intraduodenal portion of the sphincter complex; type II, all other types, including extension of the stenosis into the common bile duct (CBD).


METHODS
Tertiary referral center.


METHODS
All patients treated for iatrogenic ampullary stenosis at our institution during the last 15 years were included.


METHODS
Success of endoscopic treatment.


RESULTS
Forty-nine patients were included (mean age 54 years; 36 women; type I, n = 18, type II, n = 31). Treatment consisted of extending the sphincterotomy in type I stenoses and included stent treatment and/or balloon dilation in type II. During endoscopic treatment of ampullary stenosis, complications occurred in 8 of 49 patients. There were no procedure-related deaths. Median (range) follow-up after treatment was 2124 (240-4544) days. From an intention-to-treat perspective, endoscopic therapy of ampullary stenosis showed a long-term success rate of 83% in type I and 65% in type II CBD stenosis. In patients identified as treated successfully by endoscopy, blood samples obtained prospectively after a median (range) follow-up of 1971 (99-3320) days did not show signs of clinically relevant cholestasis.


CONCLUSIONS
Endoscopic therapy is successful in the majority of patients and should be regarded as first-line treatment for iatrogenic ampullary stenosis.
Veldkamp
Mariëlle C
MC
Department of Gastroenterology and Hepatology, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Rauws
Erik A J
EA
Dijkgraaf
Marcel G
MG
Fockens
Paul
P
Bruno
Marco J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004106:Dilatation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome