The treatment of ampullary stenosis by endoscopic sphincterotomy (EST)

A total of 247 patients with a diagnosis of ampullary stenosis were treated by endoscopic sphincterotomy (EST). Through the study period from 1983 to 1990, 70% of patients had remission of all symptoms and 82% of patients had most symptoms ameliorated. Four times as many precuts were required for patients with ampullary stenosis compared with a similar number of patients with common bile duct stones. When retained common bile duct stones are ruled out, ampullary stenosis is the most common cause for recurrent episodes of 'billary-like-colie' in postcholecystectomy patients. Ampullary stenosis should not be dismissed as a possible diagnosis just because the bile duct is not dilated or stones or 'sludge' are not identified with medical imaging. The implications for the patient and the institution of an overnight stay, rather than a 5-to-10-day stay with 'open' surgery, add further impetus to continue with this approach.