Complications of major papilla enoscopic pancreatic sphincterotomy: A review of 236 patients

Ed Esber, Stuart Shennan, Dee Earle, James Pezzi, Klaus Gottlieb, Glen Lehman

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Pancreatic sphincterotomy (PS) is used for treating pancreatic sphincter stenosis and aids in pancreatic duct (PD) access for stone removal, biopsy and stenting. We reviewed the clinical features and complications of a large series of patients undergoing PS at our institution. METfKDS: Over the past 4 years the charts of all patients who had PS were reviewed. Immediate complications were determined at the tine of the procedure. Follow-up phone calls were made within 24-72 hours to patients discharged on the day of their procedure. The diagnosis and severity or post-ERCP pancreatitis were based on standardized criteria (GI Endosc. 1991:37:383). Pancreatic stent induced changes were analyzed at the time of stent removal. PS was performed in one of 3 fashions: 1. Stent placement followed by needle knife sphincterotomy (ST/NK) (n=113), 2. Pull type sphincterotcmy followed by PD stenting (PL/ST) (n=87), 3. pull type sphincterotcmy without subsequent stenting (n=36). RESULTS: A total of 236 patients, (175, female, 61 male) were identified with a mean age of 46 (range 2-89). A concurrent de novo or extended biliary sphincterotony (BS) was performed in 90 patients (38%). PS was performed in 174 patients (74%) with either manametric evidence of pancreatic sphincter dysfunction (basal sphincter pressure > 40 mm Hg; n=151), or clinical and endoscopic parameters suggestive of pancreatic sphincter dysfunction (n=23). PS was performed in 62 patients (26%) with either pancreatic stones, PD leak or pseudocyst and to facilitate stricture biopsy. Thirty-three patients (14%) developed post-ERCP pancreatitis graded as : mild 25 (76%), moderate 7 (21%), and severe 1 (3%; this case was associated with pancreatic stent migration). Pancreatitis occurred in 27 of 174 patients (15.5%) with pancreatic sphincter dysfunction, compared to 6 of 62 patients (9.7%) with chronic pancreatitis (p=0.31). There was no statistical difference in the frequency of pancreatitis with regard to the method of sphincterotony or those patients undergoing concurrent BS. Four patients undergoing PS (3 ST/NK, 1 PL/ST) had minimal bleeding (1.7%) requiring epinephrine wash in 2 and injection in 2. Three patients (1.3%) had small perforations as a result of PS, all of which were treated medically. Of the 77 patients evaluated at the stent removal, 37 (48%) had minimal stent induced PD changes. Three stents (1.5%) migrated into the PD, requiring extension of the PS prior to retrieval in one patient, and percutaneous removal in the other. SUMMARY: PS corplications in this study were pancreatitis (14%), minimal stent induced changes in 37 of 77 patients (48%), bleeding (1.7%), and medically treated perforation (1.3%). There was no significant difference in the incidence of PS induced pancreatitis in patients with pancreatic Sphincter of Oddi dysfunction and chronic pancreatitis. CONCLUSION: PS has an equivalent or slightly higher complication rate compared to BS.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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