Iatrogenic ampullary stenosis: history, endoscopic management, and outcome in a series of 49 patients

BACKGROUND: Iatrogenic ampullary stenosis is a late complication of endoscopic interventions that affects the sphincter of Oddi. OBJECTIVE: To evaluate the history, endoscopic treatment, and outcome of iatrogenic ampullary stenosis. DESIGN: 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). SETTING: Tertiary referral center. PATIENTS: All patients treated for iatrogenic ampullary stenosis at our institution during the last 15 years were included. MAIN OUTCOME MEASUREMENTS: Success of endoscopic treatment. RESULTS: 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. CONCLUSIONS: Endoscopic therapy is successful in the majority of patients and should be regarded as first-line treatment for iatrogenic ampullary stenosis