Papillostenosis may be due to hyperplasia of the major duodenal papilla, its adenoma, scarring or edema.
The most common causes are cholelithiasis, papillitis, trauma. In particular, the cause of papillostenosis is inflammatory changes primarily emanating from the pancreas or duodenum (for example, duodenal ulcer), as well as inflammation caused by parasitic invasion.
The clinical picture is nonspecific. These include nausea, vomiting, flatulence, moderate pain, and more often a feeling of heaviness in the upper abdomen.
It is possible to establish the cause of papillostenosis with duodenoscopy (edema, adenoma) and endoscopic retrograde cholangiopancreatography, and during surgery – with the help of intraoperative cholangiography.
Also, the likely signs of papillostenosis include:
- Expansion of the common bile duct – ultrasound, ERCG, CT.
- Deceleration of the outflow of radiopaque substance (more than 45 min.) – ERCG.
- Wirsungography when performing selective ERCG.
- Slow contractions of the duodenal papilla – duodenoscopy.
- An increase in the level of bilirubin in the blood serum and the activity of transaminases (ALAT, less often AST), as well as cholestasis enzymes (alkaline phosphatase and y-glutamyltransferase).
- Increased activity of amylase and lipase.
- Frequent attacks of acute pancreatitis, when there is no alimentary factor of its occurrence.
The main method of treatment of cicatricial papillostenosis is endoscopic (and if it is improbable – surgical) papillotomy. With swelling of the major duodenal papilla or papillitis, anti-inflammatory treatment is performed, and with its adenoma, endoscopic (or surgical) removal of it.