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World J Gastroenterol. Feb 14, 2007; 13(6): 901-905
Published online Feb 14, 2007. 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, Axel Michael Marzeion, Reinhard Georg Bretzel, Hans Ulrich Kloer, Philip Daniel Hardt
Nils Ewald, Axel Michael Marzeion, Reinhard Georg Bretzel, Hans Ulrich Kloer, Philip Daniel Hardt, Third Medical Department and Policlinic, University Hospital Giessen and Marburg, Giessen Site, D-35392 Giessen, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Nils Ewald, Third Medical Department and Policlinic, University Hospital Giessen and Marburg, Giessen Site, D-35392 Giessen, Germany. nils.ewald@innere.med.uni-giessen.de
Telephone: +49-641-9942751 Fax: +49-641-9942757
Received: November 13, 2006
Revised: November 27, 2006
Accepted: January 21, 2007
Published online: February 14, 2007
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 μg/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.

Keywords: Endoscopic sphincterotomy; Fecal elastase; Chronic pancreatitis; Papillary stenosis; Oddi dysfunction