4664 Sphincter of oddi manometry and endoscopic sphincterotomy in patients with pancreatitis of unknown etiology: a long-term study and results in a tertiary referral center.

Abstract

Sphincter of Oddi dysfunction (SOD) is responsible for 15% of PUE. Limited data is available about the benefit and long-term outcome of ES. The aim of this study was to evaluate the long-term outcome of ES in this group of patients. Methods: All SOM performed for PUE were reviewed. A total of 67 studies were identified. A basal sphincter of Oddi pressure (SOP) greater than 40mmHg was considered abnormal. Nineteen out of 67 patients (28%) with clinical pancreatitis had elevated SOP.All patients had biliary sphincter manometry (BSM). If the pressure was high, biliary sphincterotomy (BS) was performed. If BSM was normal, pancreatic sphincter manometry was performed (PSM), and if high, pancreatic sphincterotomy (PS) was performed. Initially, 18 patients had BS and 1 patient had PS. All patients were admitted overnight for observation. Further follow-up was obtained by telephone interview using a standard protocol, which included 21 variables addressing pain resolution, narcotic use, the need for hospital admissions or ER visits, and any further intervention. Results: Complete follow-up was obtained in all 19 patients. The mean follow up time was 54 months (Range 6 -126). Patients were categorized in 3 groups according to the presence or absence of pain with or without narcotics, and the recurrence or not of documented pancreatitis. Eleven patients (58%) were pain free. Four patients (23.5%) had mild pain that did not require narcotics, and four patients (21%) had pain that required narcotics on a daily basis. Four patients (21%) required a second procedure, which included a SOM. Two of them had a PS because of elevated pancreatic sphincter pressure. Extension of the original sphincterotomy was performed in the remaining two because of residual biliary sphincter pressure. Complications occurred in 4 patients (21%). Three had mild pancreatitis and one patient with prior sphincteroplasty had a duodenal perforation requiring surgery. Globally, fifteen patients (79%) felt better after the ES was performed, and 4 patients (21%) had no improvement. Conclusions: 1-SOD is frequently identified in patients with PUE. 2- Initial measurement of biliary sphincter pressure is adequate for identification and treatment of most patients with pancreatitis and SOD. 3- Isolated pancreatic sphincter dysfunction requiring PS is infrequent. 4- Further studies are required to confirm these results.