Papillary stenosis in King Chulalongkorn Memorial Hospital: endoscopic findings, treatments and result.

ABSTRACT

Papillary stenosis usually presents with biliary type abdominal pain, significantly elevated liver enzymes, and cholangiogram revealing dilated common bile duct without stone. In the Western world, endoscopic biliary sphincterotomy is accepted as a standard treatment for papillary stenosis. In Asia, there are only a few reports regarding papillary stenosis. This is a report of our experience on endoscopic biliary sphincterotomy for papillary stenosis in Thai patients. From our ERCP database, twenty-five patients presented with biliary type abdominal pain, elevated liver enzymes and dilated common bile duct by ultrasonography. All of them underwent ERCP for a diagnosis of possible biliary obstruction. Of these 25 cases, seven patients with papillary stenosis were identified. All underwent endoscopic biliary sphincterotomy with or without biliary dilation and stent placement. These patients were followed for clinical improvement and normalization of liver enzymes. Endoscopic biliary sphincterotomy was successful in all patients. One patient required additional biliary dilation and stent placement. All seven patients reported significant improvement of biliary type abdominal pain. Liver enzymes also normalized 3 months after endoscopic treatment. There were no severe complications except one patient who developed post ERCP pancreatitis while another developed minimal bleeding at the sphincterotomy site. Endoscopic biliary sphincterotomy is effective and safe in patients with papillary stenosis. Results of our series are comparable to previous reports from Western countries.