title: Effects of endoscopic sphincterotomy on biliary epithelium: a case-control study.
abstract: OBJECTIVE
  To study the long-term effects of endoscopic sphincterotomy on biliary epithelium.
  
  
  METHODS
  This is a prospective case-control study. A total of 25 patients with a median age of 71 years (range 49-89 years) and prior endoscopic sphincterotomy (ES) for benign disease formed the first group. The median time from ES was 42 mo (range 8-144 mo). Another 25 patients with a median age of 76 years (range 44-94 mo) and similar characteristics who underwent current endoscopic retrograde cholangiopancreatography (ERCP) and ES for benign disease formed the second group (control group). Brush cytology of the biliary tree with p53 immunocytology was performed in all patients of both groups. ERCPs and recruitment were conducted at the Endoscopic Unit of Aretaieion University Hospital and Tzaneio Hospital, Athens, from October 2006 to June 2010.
  
  
  RESULTS
  No cases were positive or suspicious for malignancy. Epithelial atypia was higher in the first group (32% vs. 8% in the second group, P = 0.034). Acute cholangitis and previous biliary operation rates were also higher in the first group (acute cholangitis, 60% vs. 24% in the second group, P = 0.01; previous biliary operation, 76% vs. 24% in the second group, P = 0.001). Subgroup analysis showed that previous ES was the main causal factor for atypia, which was not related to the time interval from the ES (P = 0.407). Two patients (8%) with atypia in the first group were p53-positive.
  
  
  CONCLUSIONS
  ES causes biliary epithelial atypia that represents mostly reactive/proliferative rather than premalignant changes. The role of p53 immunoreactivity in biliary atypia needs to be further studied.
authors.affiliation: First Department of Surgery, Tzaneio General Hospital of Piraeus, 18536 Piraeus, Greece. ianniskal@yahoo.com
authors.forename: John
authors.initials: J
authors.lastname: Kalaitzis
authors.forename: Antonios
authors.initials: A
authors.lastname: Vezakis
authors.forename: George
authors.initials: G
authors.lastname: Fragulidis
authors.forename: Irene
authors.initials: I
authors.lastname: Anagnostopoulou
authors.forename: Spyros
authors.initials: S
authors.lastname: Rizos
authors.forename: Efstathios
authors.initials: E
authors.lastname: Papalambros
authors.forename: Andreas
authors.initials: A
authors.lastname: Polydorou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000473:pathology*; D016022:Case-Control Studies; D003584:Cytological Techniques; D004848:Epithelium / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism
chemical_list: D016159:Tumor Suppressor Protein p53