{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T01:28:16Z","timestamp":1786498096573,"version":"build-2736575974"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"CP","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background and Study Aims Biliary obstruction caused by food is a little known and rarely reported long-term complication of endoscopic sphincterotomy (ES). This retrospective study aimed to characterize patients diagnosed with this condition between 2012 and 2025 and to assess the outcomes of surgical therapy.<\/jats:p>\n                  <jats:p>Patients and Methods Patients were selected who were diagnosed with symptomatic duodenobiliary reflux of food (DBR-F) after earlier ES and who all underwent hepaticojejunostomy with partial resection or ligation of the common bile duct (CBD). DBR-F was diagnosed by pathologic examination of material extracted from the CBD during episodes of biliary obstruction. Data were assessed retrospectively using the hospital electronic patient record system. Long-term outcomes and satisfaction with treatment were also evaluated using a questionnaire.<\/jats:p>\n                  <jats:p>Results We identified 12 patients who had undergone multiple ERCPs for \u201cstone\u201d or \u201csludge\u201d removal (presurgery median 9, IQR 7.3\u201310) with microscopic proof of DBR-F. Patients presented with (episodic) abdominal pain, often associated with cholangitis. Liver abscesses were diagnosed in two cases. The median diagnostic delay was 3.3 years. Medical (antibiotics, ursodeoxycholic acid) and endoscopic (repeat sphincterotomy, stenting) treatment were ineffective. Surgical complications were observed in 4\/12 (33%) patients. Long-term patient satisfaction after surgery was excellent in 9\/10 evaluable patients.<\/jats:p>\n                  <jats:p>Conclusions This single-center series suggests that DBR-F is a long-term complication of ES that must be more prevalent than is suggested by anecdotal literature. This diagnosis should be considered when patients present with recurrent \u201cstones\u201d or \u201csludge\u201d after previous ES. In selected patients with recurrent significant symptoms associated with DBR-F, surgical therapy is an effective option.<\/jats:p>","DOI":"10.1055\/a-2923-7139","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T23:43:38Z","timestamp":1785368618000},"source":"Crossref","is-referenced-by-count":0,"special_numbering":"S","title":["Recurrent Symptomatic Biliary Obstruction due to Duodenobiliary Reflux of Food: A Largely Unknown Complication of Endoscopic Biliary Sphincterotomy"],"prefix":"10.1055","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1299-0553","authenticated-orcid":false,"given":"Henk R.","family":"van Buuren","sequence":"additional","affiliation":[{"name":"Erasmus University Medical Center, Netherlands","place":["Rotterdam"],"department":["Department of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isa N.","family":"van der Laan","sequence":"additional","affiliation":[{"name":"Erasmus University Medical Center, Netherlands","place":["Rotterdam"],"department":["Department of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie L.","family":"Cappelle","sequence":"additional","affiliation":[{"name":"Erasmus University Medical Center, Netherlands","place":["Rotterdam"],"department":["Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem J.","family":"Lammers","sequence":"additional","affiliation":[{"name":"Erasmus University Medical Center, Netherlands","place":["Rotterdam"],"department":["Department of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1053\/gast.1996.v110.pm8608900","article-title":"Biliary symptoms and complications more than 8 years after endoscopic sphincterotomy for choledocholithiasis","volume":"110","author":"F Prat","year":"1996","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1016\/j.gie.2006.12.041","article-title":"Iatrogenic ampullary stenosis: history, endoscopic management, and outcome in a series of 49 patients","volume":"66","author":"M C Veldkamp","year":"2007","journal-title":"Gastrointest Endosc"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/S0016-5107(97)70151-2","article-title":"Biliary manometry, bacterial characteristics, bile composition, and histologic changes fifteen to seventeen years after endoscopic sphincterotomy","volume":"45","author":"J J Bergman","year":"1997","journal-title":"Gastrointest Endosc"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1136\/gut.25.6.598","article-title":"Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gall bladder \u2018in situ\u2019","volume":"25","author":"J Escourrou","year":"1984","journal-title":"Gut"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1136\/pgmj.61.713.213","article-title":"Biliary sequelae of endoscopic sphincterotomy","volume":"61","author":"C Greenfield","year":"1985","journal-title":"Postgrad Med J"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/S0002-9610(85)80152-5","article-title":"Effects of sphincteroplasty and endoscopic sphincterotomy on the bacteriologic characteristics of the common bile duct","volume":"149","author":"J A Gregg","year":"1985","journal-title":"Am J Surg"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1159\/000329582","article-title":"Incidence of bactobilia increases over time after endoscopic sphincterotomy","volume":"28","author":"J S Reinders","year":"2011","journal-title":"Dig Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.gie.2008.12.054","article-title":"Reflux of duodenal contents and cholangitis in patients undergoing self-expanding metal stent placement","volume":"70","author":"S P Misra","year":"2009","journal-title":"Gastrointest Endosc"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.gie.2015.08.084","article-title":"Effectiveness of a newly designed antireflux valve metal stent to reduce duodenobiliary reflux in patients with unresectable distal malignant biliary obstruction: a randomized, controlled pilot study (with videos)","volume":"83","author":"Y N Lee","year":"2016","journal-title":"Gastrointest Endosc"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1055\/s-2001-16519","article-title":"Why do bilioduodenal plastic stents become occluded? 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