Endoscopic approach to papillary stenosis (PS).

Gastrointestinal endoscopy includes important possibilities for the diagnosis and therapy of papillary stenosis (PS). The surface of the papilla of Vater and the ampulla and the terminal common bile duct after EPT can be visualized directly. By means of ERCP the structure of the ampulla, the pancreatic duct and the biliary duct can be demonstrated. The motor activity of the sphincter of Oddi and the drainage time provide valuable information applicable to the diagnosis of PS. Histological examinations of snare and forceps biopsies are of the utmost importance for the differential diagnosis of benign and malignant PS. The advent of endoscopic papillotomy made benign PS an "endoscopic disease". In patients with benign circumscribed PS, surgical sphincterotomy is only rarely indicated. The high success rate of endoscopic papillotomy in PS makes biliary drainage by the transduodenal or the percutaneous transhepatic route superfluous in the majority of cases. We do not regard laser coagulation of papillary cancer as the treatment of choice although it may be indicated in patients who are inoperable or who refuse surgery. - Today, gastrointestinal endoscopy offers the decisive diagnostic and therapeutic approach to papillary stenosis.