Long-Term Outcome of Pancreatic Sphincterotomy in Patients with Idiopathic Acute Recurrent Pancreatitis (IARP) and Pancreatic Sphincter of Oddi Dysfunction (SOD)

Abstract

Pancreatic duct SOD is a controversial presumed cause of IARP. ERCP, pancreatic sphincter of Oddi manometry (SOM), and single or dual endoscopic sphincterotomy for SOD is recommended for patients with IARP although little patient outcome data is available. Methods: A review of patients with IARP who underwent ERCP with manometry between 1998 and 2006 was conducted. They were divided into two groups: those with documented hypertension who underwent pancreatic sphincterotomy (SOD-pES, n=36) and those with normal manometry who had no endoscopic therapy (Nl SOM, n=32). Both groups received surveys regarding their episodes of pancreatitis and quality of life both prior to, and after ERCP. Mean follow-up was 5.83 years with 15% lost to follow-up. Results: Respondents (54%) were demographically similar to non-respondents. A statistically significant reduction in severity of symptoms (P< 0.01) and ER visits (P<0.05) was reported by both groups. The SOD-pES group reported a higher mean reduction in symptom severity. When compared to the Nl SOM group, a larger percentage of the SOD-pES group reported resolution or significant improvement in symptoms (75% vs 47%) and a lesser rate of relapse (6% vs 14%). This difference was maintained with a statistically significant reduction in narcotic use (P<0.05), frequency of physician- (P<0.05) and self-diagnosed (P<0.001) episodes of pancreatitis. A larger percentage of the SOD-pES group reported improvement in overall condition (63% vs 30%), with a statistically significant improvement in the mean score (P<0.05). In contrast, a large majority of Nl SOM group reported no change or worsening of symptoms (70% vs 27.5%). Conclusion: Compared to IARP patients with normal SOM and no endoscopic therapy, IARP patients with manometry-proven pancreatic SOD derived a sustained clinical benefit from pancreatic sphincterotomy.