ERCP/Manometry Findings in 1,343 Idiopathic Pancreatitis Patients

Abstract

Background: ERCP with sphincter of Oddi manometry can detect abnormalities in patients otherwise classified as idiopathic pancreatitis. Methods: All patients undergoing ERCP at Indiana University Medical Center have data prospectively entered into a database. 1,547 patients from 1994-2006 were classified initially as idiopathic pancreatitis. After review of medical history, non-invasive imaging, prior endoscopies, and blood studies, 204 patients were eliminated for known causes of pancreatitis. This study reviews the findings of ERCP with or without manometry of the remaining 1,343 patients in correlation with the pre-ERCP clinical diagnosis. Results: Clinical categories were based upon the pre-ERCP diagnosis: a single episode of acute pancreatitis in 281 (20.9%), acute recurrent pancreatitis (IARP) in 758 (56.4%), chronic pancreatitis (CP) in 304 (22.6%). Post-procedure diagnoses were: (See table). Biliary manometry findings were the following: elevated biliary sphincter pressures were found in 63 (41.7%) of the 151 attempted manometries in patients with 1 documented episode of pancreatitis, in 153 (32.9%) patients with acute recurrent pancreatitis of the 465 performed manometries, and in 30 (23.6%) of 127 manometries of CP. Elevated major pancreatic sphincter pressures were found in 93/154 (60.4%) with acute pancreatitis x1, in 266/488 (54.5%) with acute recurrent pancreatitis, and in 69/158 (43.7%) with chronic pancreatitis. Summary: In our large case series of idiopathic pancreatitis patients, ERCP and manometry frequently detects abnormalities that may be a cause of pancreatitis or lead to persistence of symptoms. Manometry abnormalities are the most common treatable cause of idiopathic pancreatitis. Long term outcomes of therapy studies are in progress. Conclusion: ERCP with sphincter of Oddi manometry is indicated for most patients with idiopathic pancreatitis. Tabled 1 ERCP findings Number of patients % of total Sphincter of Oddi dysfunction 539 40.1 Pancreas divisum 240 17.9 Periampullary diverticulum 82 6.1 Choledocholithiasis 61 4.6 Intraductal mucinous tumors 55 4.1 Cholelithiasis (alone) 26 1.9 Anomalous pancreatobiliary junction 7 0.5 Choledochocele 5 0.4 Papilla of Vater adenoma/cancer 4 0.3 Annular pancreas 4 0.3 Open table in a new tab