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Sphincterotomy-associated biliary strictures: Features and endoscopic management
- Source :
- Gastrointestinal Endoscopy; October 2000, Vol. 52 Issue: 4 p494-499, 6p
- Publication Year :
- 2000
-
Abstract
- Background:“Sphincterotomy stenosis” is a recognized late complication of endoscopic biliary sphincterotomy. The narrowing is limited to the biliary orifice and can be managed simply by repeat sphincterotomy. A similar but poorly characterized post-sphincterotomy complication involves narrowing that extends from the biliary orifice for a variable distance along the bile duct, beyond the duodenal wall. This lesion cannot be managed by repeating the sphincterotomy. Methods:Six patients (3 men) are described with sphincterotomy associated biliary strictures, all smooth and high grade, presenting at a median of 19 months (range 8 to 60 months) after sphincterotomy. Further sphincterotomy was not possible as an intra-duodenal segment of bile duct was no longer visible. Endoscopic management consisted of serial incremental stent exchange at 2- to 4-month intervals. The goal of therapy was to place two 11.5F stents side-by-side. Results:Stricture resolution was documented by cholangiography in all patients. One patient with a stricture resistant to treatment required three 10F stents side-by-side, and another underwent treatment to a maximum of adjacent 11.5F and 7F stents. Two 11.5F stents were eventually placed in the other four patients. Overall median duration of stent placement was 12.5 months. At a median of 26.5 months of stent-free follow-up, all patients remain asymptomatic. Conclusion:Sphincterotomy-associated biliary strictures are a distinct late complication of biliary sphincterotomy. These recalcitrant lesions are not amenable to repeat sphincterotomy; however, the results of this study suggest that they may be managed successfully by serial placement of stents of incrementally increasing diameter. (Gastrointest Endosc 2000;52:494-9).
Details
- Language :
- English
- ISSN :
- 00165107
- Volume :
- 52
- Issue :
- 4
- Database :
- Supplemental Index
- Journal :
- Gastrointestinal Endoscopy
- Publication Type :
- Periodical
- Accession number :
- ejs22730128
- Full Text :
- https://doi.org/10.1067/mge.2000.108970