Iatrogenic ampullary stenosis: history, endoscopic management, and outcome in a series of 49 patients

Abstract

Iatrogenic ampullary stenosis is a late complication of endoscopic interventions that affects the sphincter of Oddi. To evaluate the history, endoscopic treatment, and outcome of iatrogenic ampullary stenosis. 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). Tertiary referral center. All patients treated for iatrogenic ampullary stenosis at our institution during the last 15 years were included. Success of endoscopic treatment. 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. Endoscopic therapy is successful in the majority of patients and should be regarded as first-line treatment for iatrogenic ampullary stenosis.