Veldkamp Mariëlle C, Rauws Erik A J, Dijkgraaf Marcel G, Fockens Paul, Bruno Marco J
Department of Gastroenterology and Hepatology, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Gastrointest Endosc. 2007 Oct;66(4):708-16; quiz 768, 770. doi: 10.1016/j.gie.2006.12.041. Epub 2007 Jul 20.
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.
医源性壶腹狭窄是影响Oddi括约肌的内镜干预的晚期并发症。
评估医源性壶腹狭窄的病史、内镜治疗及结果。
回顾并分析患者病历、内镜报告及X线片并评分。通过与主治专家、普通内科医生及患者联系获取长期随访数据。壶腹狭窄分为2型：I型，局限于括约肌复合体的十二指肠内部分；II型，所有其他类型，包括狭窄延伸至胆总管（CBD）。
三级转诊中心。
纳入过去15年在我院接受医源性壶腹狭窄治疗的所有患者。
内镜治疗的成功率。
纳入49例患者（平均年龄54岁；女性36例；I型18例，II型31例）。I型狭窄的治疗包括延长括约肌切开术，II型狭窄的治疗包括支架置入和/或球囊扩张。在壶腹狭窄的内镜治疗过程中，49例患者中有8例发生并发症。无手术相关死亡病例。治疗后的中位（范围）随访时间为2124（240 - 4544）天。从意向性治疗的角度来看，壶腹狭窄的内镜治疗在I型狭窄中的长期成功率为83%，在II型CBD狭窄中为65%。在内镜治疗成功的患者中，中位（范围）随访1971（99 - 3320）天后采集的血样未显示临床相关胆汁淤积的迹象。
内镜治疗对大多数患者有效，应被视为医源性壶腹狭窄的一线治疗方法。
