Endoscopic pancreatic duct sphincterotomy (EPS) is being performed with increasing frequency for a variety of pancreatic disorders. Despite its increased use, most of the reports have contained small numbers of patients, and very little information is available regarding the long-term outcomes of this procedure. Methods: We reviewed the charts of all patients undergoing EPS at our institution from 6/92 to 7/97. Patients were contacted by phone to determine their long-term response to therapy. Results: 148 patients underwent EPS over the 5-year period and had charts available for review. There were 50 males and 98 females with a mean (±SD) age of 50 ±15.9 years (range 8 to 85 years). The indications for EPS included sphincter of Oddi dysfunction (SOD) (n = 34), pancreatic pseudocyst (n = 24). acute recurrent pancreatitis (ARP) (n = 23), pancreatic duct calculi (PDC) (n = 23), ampullary or pancreatic mass (n-20), chronic pancreatitis (CP) (n = 18), pancreatic duct leak (n = 3), recurrent pancreatitis from gallstones (n=2), and hereditary pancreatitis (n=1). EPS was performed with a sphincterotome oriented along the axis of the pancreatic duct (n = 109), over a guidewire (n = 21), or with a needle-knife (n-18). Immediate complications from EPS included pancreatitis (n=14), bleeding (n=4), perforation (n=l), and sepsis (n=1). The incidence of pancreatitis was significantly higher in patients with SOD as compared with other indications (24% vs 5%, p = 0.004). Follow-up was available for 123 patients (83%) with a mean (±SD) follow-up of 19.5±12.6 months (range 6 to 63 months). Pain was significantly improved or resolved after EPS in 73% of patients with SOD and 60% of patients with CP. PDC were successfully removed in 82% of patients after EPS. EPS was effective in preventing further episodes of acute pancreatitis in 65% of patients with ARP. Conclusions: Long-term follow-up in this large series of patients confirms that EPS is a reasonable therapeutic option for pain control in patients with SOD as well as patients with CP. EPS also facilitates removal of PDC and may prevent further episodes of pancreatitis in patients with ARP. As is true for biliary sphincterotomy, the risk of pancreatitis is significantly higher in patients with SOD undergoing EPS than it is in patients undergoing EPS for other indications.
|State||Published - Dec 1 1998|