Endoscopy in the diagnosis and treatment of benign stenosis of the papilla of Vater.

Of 921 endoscopic sphincterotomies (EST) performed by the authors, 110 (12%) were done for benign stenosis of papilla of Vater. Based on these data, they consider the possibilities of endoscopic diagnosis and treatment in the stenosis of papilla. One of the conditions for the diagnosis of papilla stenosis is the detectability of dilated biliary tract by endoscopic retrograde cholangiography. But this cannot be taken as a specific sign because, e.g., the biliary tract may become dilated in spite of normal sphincter tone after gall-bladder removal. At the same time, biliary tract dilation is a diagnostic criterion for papilla stenosis, and abnormal findings in biliary scintigraphy and the laboratory syndrome consistent with cholestasis cannot be avoided. EST is the method of first choice in the treatment of papilla stenosis in comparison to surgery. The complications of EST, however, occur in papilla stenosis more frequently than in choledocholithiasis (8.8%). Bleeding and cholangitis are responsible for the excess incidence.