Endoscopic management of sump syndrome after choledochoduodenostomy: retrospective analysis of 30 cases

Background: Side-to-side choledochoduodenostomy is a frequently performed o peration, Postoperative biliary "sump syndrome" is infrequent, a complicati on for which endoscopic sphincterotomy is regarded as the treatment of choi ce. Methods: We retrospectively analyzed 30 cases of sump syndrome and describe the symptoms, the delay before the appearance of symptoms, laboratory abno rmalities, the nature of the biliary obstruction, and the outcome of endosc opic sphincterotomy including its efficiency and complications. Results: The median clinical latency was 5 years (range 1 month to 28 years ), the median delay between surgery and diagnosis was 6 years (range 1 mont h to 28 years), Fourteen patients had abdominal pain with fever, 5 had isol ated abdominal pain, 4 had post-prandial pain, 4 had hepatic abcesses, and 3 had acute pancreatitis. Liver function tests were abnormal in 79%. During endoscopic retrograde cholangiopancreatography, food debris was identified in 18 patients in the biliary sump, biliary calculi in 10 patients, and a mixture of food and calculi in 2 patients. All patients underwent endoscopi c sphincterotomy without complication, Recurrence during a median followup of 36 months (range 3 months to 11 years) was not observed. Conclusions: Sump syndrome most often becomes symptomatic only after a long delay. Abdominal pain with fever was the most frequent symptom. Liver func tion tests were abnormal in the majority of patients. Food debris was the m ost frequent cause. Endoscopic sphincterotomy appeared to be a safe, reliab le treatment.