Recurrent Symptomatic Biliary Obstruction due to Duodenobiliary Reflux of Food: A Largely Unknown Complication of Endoscopic Biliary Sphincterotomy: A single-center case series including the results of surgical therapy.

Background and Study Aims Biliary obstruction caused by food is a little known and rarely reported long-term complication of endoscopic sphincterotomy (ES). This retrospective study aimed to characterize patients diagnosed with this condition between 2012 and 2025 and to assess the outcomes of surgical therapy. Patients and Methods Patients were selected who were diagnosed with symptomatic duodenobiliary reflux of food (DBR-F) after earlier ES and who all underwent hepaticojejunostomy with partial resection or ligation of the common bile duct (CBD). DBR-F was diagnosed by pathologic examination of material extracted from the CBD during episodes of biliary obstruction. Data were assessed retrospectively using the hospital electronic patient record system. Long-term outcomes and satisfaction with treatment were also evaluated using a questionnaire. Results We identified 12 patients who had undergone multiple ERCPs for "stone" or "sludge" removal (presurgery median 9, IQR 7.3-10) with microscopic proof of DBR-F. Patients presented with (episodic) abdominal pain, often associated with cholangitis. Liver abscesses were diagnosed in two cases. The median diagnostic delay was 3.3 years. Medical (antibiotics, ursodeoxycholic acid) and endoscopic (repeat sphincterotomy, stenting) treatment were ineffective. Surgical complications were observed in 4/12 (33%) patients. Long-term patient satisfaction after surgery was excellent in 9/10 evaluable patients. Conclusions This single-center series suggests that DBR-F is a long-term complication of ES that must be more prevalent than is suggested by anecdotal literature. This diagnosis should be considered when patients present with recurrent "stones" or "sludge" after previous ES. In selected patients with recurrent significant symptoms associated with DBR-F, surgical therapy is an effective option.