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. 2007 Feb 14;13(6):901-5.
doi: 10.3748/wjg.v13.i6.901.

Endoscopic sphincterotomy in patients with stenosis of ampulla of Vater: three-year follow-up of exocrine pancreatic function and clinical symptoms

Nils Ewald  1 , Axel Michael Marzeion, Reinhard Georg Bretzel, Hans Ulrich Kloer, Philip Daniel Hardt
Affiliations

Endoscopic sphincterotomy in patients with stenosis of ampulla of Vater: three-year follow-up of exocrine pancreatic function and clinical symptoms

Nils Ewald et al. World J Gastroenterol. .

Abstract

Aim: To investigate retrospectively the long-term effect of endoscopic sphincterotomy (ES) including exocrine pancreatic function in patients with stenosis of ampulla of Vater.

Methods: 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.

Results: 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.

Conclusion: 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.

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Figures

Figure 1
Figure 1
Clinical symptoms prior to and after endoscopic sphincterotomy due to the visual analogue scale (0 = not present, 10 = maximum complaint), n = 55.
Figure 2
Figure 2
Levels of fecal elastase-1 of patients with initially impaired exocrine pancreatic function (< 200 μg/g; n = 26) prior to and after endoscopic sphin-cterotomy. Medians and interquartiles given.
See this image and copyright information in PMC

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