Causes and complications of multiple repeated endoscopic sphincterotomies

There is little information on the background of repeated endoscopic sphincterotomies (re-EST). We have examined frequency and background of complications of re-EST in our tertiary endoscopic center. Patients and method: Between 1999 and 2004, we retrospectively investigated the medical records of patients who underwent endoscopic retrograde choledocho-pancreatography (ERCP) with several (two or more) re-EST-s. Results: During the 6 years there were 6504 ERCPs including 1689 cases of EST and 266 cases of re-EST with the following etiologies: adenoma of the papilla: 34.2%, choledocholithiasis: 28.2%, chronic calcifying pancreatitis: 12.0%, previous incomplete EST: 5.6%, papillitis: 3.1%, acute pancreatitis: 2.6%, pancreatic tumor: 2.6%, gallbladder tumor: 1.9%, papillary sclerosis: 1.5%, choledochus tumor: 1.5%, tumor of the papilla: 0.8%. The number of patients who repeatedly (twice or more) underwent re-EST was 29. In these cases re-EST was performed 76 times (with an average of 2.6 per patient). The most frequent reasons for re-EST were: choledocholithiasis: 33 (43.2%), papillary adenoma: 29 (38.2%), papilla restenosis of unknown origin: 9 (11.8%), cholangitis: 6 (7.9%), juxtapapillary diverticla: 5 (6.6%), previous incomplete EST: 4 (5.3%), papillary sclerosis: 4 (5.3%), chronic calcifying pancreatitis: 2 (2.6%), choledochus stricture: 2 (2.6%), mucin producing neo plasma: 2 (2.6%), pancreatic carcinoma: 2 (2.6%), papillitis: 2 (2.6%) and acute pancreatitis: 1 (1.3%) The following complications were found in 25% of all re-EST-s bleeding (no transfusion required): 8 (10.5%), cholangitis: 7 (9.2%), pancreatitis: 2 (2.6%), hepatic abscess: 1 (1.3%), choledochus stricture: 1 (1.3%). Summary: In the examined population of patients (including difficult cases of several hospitals) re-EST was required mostly in cases of choledocholithiasis, adenoma of the papilla and restenosis of unkown origin. Most frequent complications were minor bleedings, cholangitis and pancreatitis. A sufficient length of the primary sphincterotomy probably prevents restenosis of the papilla.