Ewald Nils, Marzeion Axel Michael, Bretzel Reinhard Georg, Kloer Hans Ulrich, Hardt Philip Daniel
Third Medical Department and Policlinic, University Hospital Giessen and Marburg, Giessen Site, D-35392 Giessen, Germany.
World J Gastroenterol. 2007 Feb 14;13(6):901-5. doi: 10.3748/wjg.v13.i6.901.
To investigate retrospectively the long-term effect of endoscopic sphincterotomy (ES) including exocrine pancreatic function in patients with stenosis of ampulla of Vater.
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.
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.
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.
回顾性研究内镜下括约肌切开术（ES）对 Vater 壶腹狭窄患者的长期影响，包括外分泌胰腺功能。
对因 Vater 壶腹狭窄（SOD I 型）行诊断性内镜逆行胰胆管造影（ERCP）及 ES 后的 60 例患者进行随访检查（平均随访时间 37.7 个月）。使用标准问卷询问患者目前及干预前的临床症状和体征。ES 前后通过测定免疫反应性粪便弹性蛋白酶 1 评估外分泌胰腺功能。检测提示胆汁淤积的血清酶以及血清脂肪酶和淀粉酶。
80%的患者报告 ES 后总体状况有所改善。ES 后所有患者的粪便弹性蛋白酶 1 浓度（FEC）均显著升高。这种效应在 ES 前粪便弹性蛋白酶浓度病理性降低（<200μg/g）的患者中更为明显。ES 后血清脂肪酶、淀粉酶以及血清碱性磷酸酶（AP）和γ-谷氨酰转肽酶（GGT）水平显著降低。
本研究结果表明，内镜下括约肌切开术可成功治疗 Vater 壶腹狭窄患者。积极效果不仅体现在临床症状和胆汁淤积的持续改善上，还体现在外分泌胰腺功能的改善上。
