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Effects of endoscopic sphincterotomy on biliary epithelium:A case-control study

World Journal of Gastroenterology 2012年第8期18卷 794-799页

作者： John Kalaitzis Antonios Vezakis George Fragulidis Irene Anagnostopoulou Spyros Rizos Efstathios papalambros Andreas polydorou First Department of Surgery Tzaneio General Hospital of Piraeus Second Department of Surgery and Endoscopic Unit National and Kapodistrian University of Athens Medical School Aretaieion Hospital Department of Cytology Tzaneio General Hospital of Piraeus First Department of Surgery National and Kapodistrian University of Athens Medical School Laiko General Hospital

AIM: To study the long-term effects of endoscopic sphincterotomy on biliary epithelium. METHODS: This is a prospective case-control study. A total of 25 patients with a median age of 71 years (range 49-89 years) and prior endoscopic sphincterotomy (ES) for benign disease formed the fi rst group. The median time from ES was 42 mo (range 8-144 mo). Another 25 patients with a median age of 76 years (range 44-94 mo) and similar characteristics who underwent current endoscopic retrograde cholangio-pancreatography (ERCp) and ES for benign disease formed the second group (control group). Brush cytology of the biliary tree with p53 immunocytology was performed in all patients of both groups. ERCps and recruitment were conducted at the Endoscopic Unit of Aretaieion University Hospital and Tzaneio Hospital, Athens, from October 2006 to June 2010. RESULTS: No cases were positive or suspicious for malignancy. Epithelial atypia was higher in the first group (32% vs 8% in the second group, p = 0.034). Acute cholangitis and previous biliary operation rates were also higher in the fi rst group (acute cholangitis, 60% vs 24% in the second group, p = 0.01; previous biliary operation, 76% vs 24% in the second group, p = 0.001). Subgroup analysis showed that previous ES was the main causal factor for atypia, which was not related to the time interval from the ES (p = 0.407). Two patients (8%) with atypia in the fi rst group were p53-positive. CONCLUSION: ES causes biliary epithelial atypia that represents mostly reactive/proliferative rather than premalignant changes. The role of p53 immunoreactivity in biliary atypia needs to be further studied.

关键词： Endoscopic sphincterotomy Brush cytolo-gy Atypia Cholangiocarcinoma p53 immunocytology

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