Long-term biliary endoscopic XXXX : incidence, endoscopic management, and complications of retreatment.

@entity1 @entity788 @entity548 @entity532 @entity256
BACKGROUND: Ampullary restenosis is a late complication of biliary endoscopic sphincterotomy. Long-term data are limited regarding both the rate of @entity532 resulting from repeat therapy. AIMS: To determine the incidence of post @entity256 and the effectiveness of endoscopic therapy in the management of this entity. METHODS: A retrospective review of medical charts and the endoscopic retrograde cholangiopancreatography (ERCP) database to identify @entity1 with ERCP and biliary endoscopic sphincterotomy during the period 1998-2002 at the University of Iowa Hospitals was conducted. All subjects were contacted by phone and asked about the recurrence of their pancreatobiliary symptoms after the first ERCP and whether they sought any medical treatment for these symptoms. The primary outcome was restenosis of the sphincterotomy site and the secondary outcome was complications of endoscopic treatment of @entity256 . RESULTS: A total of 202 @entity1 underwent ERCP and biliary endoscopic sphincterotomy on an intact major papilla. Of these, n = 80 @entity1 (54.7 +/- 19 years of age, 76% female) consented and enrolled in the study. Among these, n = 13 (16%) developed ampullary restenosis in 1-62 (median 16) months after the index ERCP. These 13 @entity1 underwent a total of 24 ERCPs (range 1-4 for each @entity1 ) for repeat biliary sphincterotomy and biliary stenting, if needed. Repeat biliary endoscopic sphincterotomy was successful in 12/13 (92%) @entity1 . Complications of repeat biliary endoscopic sphincterotomy were seen in three @entity1 : mild @entity788 (n = 1), severe @entity548 (n = 1), and severe duodenal perforation (n = 1). CONCLUSIONS: Long-term restenosis is an important sequella of biliary endoscopic sphincterotomy. Repeat biliary endoscopic sphincterotomy is an effective treatment modality, but complications are not negligible.
