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Endoscopic sphincterotomy in patients with stenosis of ampulla of Vater:Three-year follow-up of exocrine pancreatic function and clinical symptoms

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World Journal of Gastroenterology 2007年第6期13卷 901-905页

作者： Nils Ewald Axel Michael Marzeion Reinhard Georg Bretzel hans ulrich kloer Philip Daniel Hardt Third Medical Depart-ment and Policlinic University Hospital Giessen and Marburg Giessen Site D-35392 Giessen Germany

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 clini-cal signs and symptoms at present and before interven-tion using a standard questionnaire. Before and after ES exocrine pancreatic function was assessed by determina-tion of immunoreactive fecal elastase 1. Serum enzymes indicating cholestasis as well as serum lipase and amy-lase were measured. RESULTS: Eighty percent of patients reported an im-provement 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 signifi-cantly 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.

关键词： Endoscopic sphincterotomy Fecal elastase Chronic pancreatitis Papillary stenosis Oddi dysfunction

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