Garrett F Mortensen, MD, Neal Bhutiani, MD, Amber N Brown, Vladimir Davidyuk, MD, Hannah Palin, Michael H Bahr, MD, Gary C Vitale, MD. University of Louisville
Background: Biliary colic after cholecystectomy in patients with minimal biliary ductal dilation and no evidence of biliary stones or malignancy represents a difficult clinical situation. While endoscopic methods can be used for symptom relief, their safety and efficacy have not been clearly demonstrated in this patient population. This study aimed to assess efficacy of endoscopic management in patients with abdominal pain in the presence of minimal biliary ductal dilation and no evidence of stone disease or malignancy.
Methods: A single institution database was queried for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for abdominal pain between 1996 and 2016 with a common bile duct diameter of ≤ 12mm. All patients had undergone prior cholecystectomy, were free of stone disease or malignancy, and did not have evidence of biliary ductal dilation. Gender, age, body mass index (BMI), serologic tests, and common bile duct (CBD) and pancreatic duct (PD) diameter were recorded. The number, type, and interval between endoscopic interventions were also evaluated along with the development of complications following endoscopic intervention. Duration of follow-up was noted along with the presence of abdominal pain at last follow-up.
Results: 35 patients underwent a collective total of 99 ERCPs. The majority (30 (86%)) were female and the median age was 57 (range 27-84). Median BMI was 26.3 (range 18.1-39.3). Serological tests upon initial evaluation demonstrated at most a mild transaminitis or amylasemia among patients in this cohort (Table 1). Median CBD diameter was 10 mm (range 4-12 mm), and median PD diameter was 2.8 mm (range 1.1 – 5.7 mm). 31 patients (89%) underwent sphincterotomy, 28 (80%) underwent stent placement, and 5 (14%) underwent balloon dilatation. 29 patients (83%) underwent a subsequent ERCP, and median number of ERCPs performed was 2 (range 1-10). Three of 35 patients (9%) developed post-ERCP pancreatitis at some point during their treatment. Among patients undergoing multiple ERCPs, median time between ERCP 1 and 2 was 77 days (range 12 – 4897 days), and median time between ERCP 2 and 3 was 98 days (range 45-1683 days). At last follow-up since initial ERCP (median 16 months, range 2.4 – 184 months), 23 (66%) patients were free from abdominal pain.
Conclusion: For patients with abdominal pain in the setting of minimal CBD dilation and no evidence of stone disease or malignancy, ERCP can safely and effectively be used to manage symptoms. While patients may require multiple interventions, they can derive long-term relief.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88321
Program Number: P377
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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