TY - JOUR
T1 - Is peripapillary choledochoduodenal fistula an indication for endoscopic sphincterotomy?
AU - Ohtsuka, Takao
AU - Tanaka, Masao
AU - Inoue, Ken
AU - Nabae, Toshinaga
AU - Takahata, Shunichi
AU - Yokohata, Kazunori
AU - Yamaguchi, Koji
AU - Chijiiwa, Kazuo
AU - Ikeda, Seiyo
PY - 2001
Y1 - 2001
N2 - Background: Most patients with a peripapillary choledochoduodenal fistula undergo fistulotomy by endoscopic sphincterotomy for the treatment of bile duct stones. However, whether sphincterotomy should be performed in patients with the fistula but without stones is controversial. Methods: Among 165 patients in whom a benign peripapillary choledochoduodenal fistula was diagnosed at ERCP, the clinical outcome was retrospectively analyzed and compared between those who underwent fistulotomy by endoscopic sphincterotomy (group 1) and those whose fistula was left untreated (group 2). All patients with hepatolithiasis, residual stones, biliary diversion, or transduodenal papilloplasty were excluded (32, leaving 133). Fistulas were divided into types I and II according to the location of the fistula (Ikeda classification). Results: Follow-up data collected during a median period of 124 months were available for 127 of 133 patients (95%), 78 in group 1 and 53 in group 2. Late complications were bile duct stone recurrence (17 patients), acute cholangitis (7 patients), and biliary carcinoma (2 patients). The incidence of stone recurrence was not significantly different between the 2 groups (p = 0.1). In group 2, 4 patients (8%) with an untreated type II fistula had I to 3 episodes of presumed reflux cholangitis, which resolved quickly with conservative treatment. Conclusions: Endoscopic sphincterotomy is not always necessary for peripapillary choledochoduodenal fistulas if bile duct stones are absent because reflux cholangitis is a relatively rare complication that can be easily managed.
AB - Background: Most patients with a peripapillary choledochoduodenal fistula undergo fistulotomy by endoscopic sphincterotomy for the treatment of bile duct stones. However, whether sphincterotomy should be performed in patients with the fistula but without stones is controversial. Methods: Among 165 patients in whom a benign peripapillary choledochoduodenal fistula was diagnosed at ERCP, the clinical outcome was retrospectively analyzed and compared between those who underwent fistulotomy by endoscopic sphincterotomy (group 1) and those whose fistula was left untreated (group 2). All patients with hepatolithiasis, residual stones, biliary diversion, or transduodenal papilloplasty were excluded (32, leaving 133). Fistulas were divided into types I and II according to the location of the fistula (Ikeda classification). Results: Follow-up data collected during a median period of 124 months were available for 127 of 133 patients (95%), 78 in group 1 and 53 in group 2. Late complications were bile duct stone recurrence (17 patients), acute cholangitis (7 patients), and biliary carcinoma (2 patients). The incidence of stone recurrence was not significantly different between the 2 groups (p = 0.1). In group 2, 4 patients (8%) with an untreated type II fistula had I to 3 episodes of presumed reflux cholangitis, which resolved quickly with conservative treatment. Conclusions: Endoscopic sphincterotomy is not always necessary for peripapillary choledochoduodenal fistulas if bile duct stones are absent because reflux cholangitis is a relatively rare complication that can be easily managed.
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U2 - 10.1016/S0016-5107(01)70404-X
DO - 10.1016/S0016-5107(01)70404-X
M3 - Article
C2 - 11231389
AN - SCOPUS:0035092361
VL - 53
SP - 313
EP - 317
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 3
ER -