Duodenal obstruction following papillary stenosis: a rare complication after endoscopic sphincterotomy

Background: Iatrogenic papillary stenosis is one of clinically significant long-term complications of endoscopic sphincterotomy(EST),but duodenal obstruction following papillary stenosis is rare complication and has not been reported. Case: An 80-year-old man was admitted for abdominal pain and jaundice.Abdominal computed tomography and endoscopic retrograde cholangiopancreatography(ERCP) revealed a bile duct stone impacted at the duodenal papilla with the biliary and pancreatic duct dilatation.We performed an EST and stone extraction.Eighteen months later,He was readmitted due to abdominal pain and jaundice.ERCP showed retraction of the duodenal papilla with stenosis of the biliary and pancreatic duct orifices.We performed biliary balloon dilatation with stent placement and pancreatic sphincterotomy.The patient then underwent repeated ERCPs with balloon dilatation and stent placement at 3-month intervals.During follow up period,retraction of the duodenal papilla was progressed and duodenal lumen at the papillary level was begun to be narrowed.2 years after the first admission,the patient began to suffer from sustained vomiting.Gastrografin study showed duodenal obstruction at the papillary level.We repeatedly performed balloon dilatation for the duodenal obstruction.However,duodenal obstruction showed progresson.The patient’s general status was extremely poor to undergo for surgery;he finally died from biliary sepsis. Conclusion: We suggest that endoscopists need to be aware of these EST-related complications during the follow-up.