3797 Long term outcome of endoscopic therapy for sphincter of oddi dysfunction.

Abstract

Long-term outcomes after sphincterotomy (ES) for SOD are not well known, especially for pancreatic (P) as well as biliary (B) ES. Clinical predictors of outcome other than duct dilation or LFT abnormalities are not well clarified. Methods:We prospectively studied 126 consecutive patients treated over 3 yr for SOD (recurrent pain suspected to be from structural or functional P/B sphincter abnormality, +/- any clinical evidence of P/B abnormality): 92% female, 87% post-chole, 41% nl LFT's + nondilated B duct (type III), 19% recurrent pancreatitis, and 18% with prior B ES elsewhere. SO manometry (mano) was done in 87%. All pts had B ES; indication for P ES was abnl P mano or hx pancreatitis, usually reserved for poor response to B ES. Nonresponders had repeat ERCP to point of total ablation of the treated sphincter(s). Pts graded final pain relief on a 5-point Likert scale: with excellent (total resolution) or good (substantially better) = improved, and fair (minor improvement), poor (no change) or very poor (worse) = not improved. Results: Of 121 pts with 1-4 yr f/u, 83 (69%) were improved: 61 (50%) required more than 1 ERCP, and 49 (40%) P ES. Final improvement occurred in 78% of pts requiring only 1 ERCP, but also in 60% of pts requiring 2-6 total ERCP's. Response was similar for type III vs others (62% v 73%), but more (50% v 34%) required P ES. Of 27 variables examined, multivariate predictors (p 1 ERCP. Not predictive were: abnl B or P enzymes, dilated B or P ducts, abnormal B mano, prior B ES elsewhere, chronic pancreatitis by EUS/ERP, location/duration or hospitalization for pain, depression, IBS, or other concomitant pain syndrome. Conclusion: Endoscopic treatment of SOD resulted in long term improvement in about 2/3 pts, using biliary ES in all plus selective pancreatic ES. Repeated ERCP's were required in half of pts and salvaged 60% of nonresponders to initial ES. Response was similar for type III (pain only) as for other pts, and traditional classification based on abnormal enzymes and duct dilation did not predict outcome. Clinical features including younger age, daily narcotic use, and gastroparesis did lessen likelihood of response. These results highlight the importance of global clinical assessment, pancreatic mano and ES, and repeated ERCP in order to achieve optimal outcomes for SOD