Stenosis of the hepato-pancreatic ampulla may be idiopathic or may develop as a result of trauma due to gallstones. It is often sought as an explanation for secondary manifestations of biliary obstruction - jaundice, raised alkaline phosphatase, cholangitis - when gallstones or some other obstructing lesion is absent, and a dilatation of the common duct is seen on cholangiography.
There is no definitive diagnostic investigation for ampullary stenosis but ERCP is required to establish the absence of gallstones. Ampullary and ductal pressure measurements obtained through the endoscope are currently being evaluated as a test.
Treatment is by endoscopic sphincterectomy or transduodenal surgical sphincteroplasty in carefully selected patients.
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