Gastrointestinal endoscopy includes important possibilities for the diagnosis and
therapy of papillary stenosis (PS). The surface of the papilla of Vater and the ampulla
and the terminal common bile duct after EPT can be visualized directly. By means of
ERCP the structure of the ampulla, the pancreatic duct and the biliary duct can be
demonstrated. The motor activity of the sphincter of Oddi and the drainage time provide
valuable information applicable to the diagnosis of PS. Histological examinations
of snare and forceps biopsies are of the utmost importance for the differential diagnosis
of benign and malignant PS. The advent of endoscopic papillotomy made benign PS an
“endoscopic disease”. In patients with benign circumscribed PS, surgical sphincterotomy
is only rarely indicated. The high success rate of endoscopic papillotomy in PS makes
biliary drainage by the transduodenal or the percutaneous transhepatic route superfluous
in the majority of cases. We do not regard laser coagulation of papillary cancer as
the treatment of choice although it may be indicated in patients who are inoperable
or who refuse surgery. - Today, gastrointestinal endoscopy offers the decisive diagnostic
and therapeutic approach to papillary stenosis.
Papilla of Vater - Sphincter of Oddi - Papillary stenosis - Endoscopic papillotomy
