PTH-082 Development and delivery of a low-cost regional sphincter of Oddi manometry service

Abstract

<h3>Introduction</h3> Sphincter of Oddi (SO) dysfunction (SOD) is a functional disorder that can cause severe morbidity. SO manometry (SOM) measures SO pressure (SOP) and is the definitive test for SOD.1 SOD can be treated with sphincterotomy.1 ERCP in patients with SOD increases risk of complications.23 Sphincterotomy can cause long-term complications.4 As such patient selection and pre-procedure counselling is paramount.5 SOM is not widely available (in UK) and commercial SOM equipment is expensive. <h3>Methods</h3> We retrospectively evaluated the first 18 months of a new SOM service. Patients were referred from Northern region clinicians. After careful selection those with type II SOD were offered SOM. An in-house manometric system was developed using a water-perfused system constructed from existing invasive BP measuring equipment and a standard SOM catheter. Before use it was evaluated and produced reliable and valid pressure measurements comparable with commercial systems. <h3>Results</h3> Between 1/2008 and 7/2009, 29 patients (25F:4M) underwent SOM (36 procedures), following MRCP in 26, endoscopic ultrasound in 24 and SO Botox injection in 11. SO hypertension (SOH) was diagnosed in 16 and 18 patients underwent sphincterotomy (16-SOH, 1-choledocholithiasis, 1-dilated CBD at MRCP). There were five episodes of pancreatitis (14%) and one episode of cholangitis (after 36 SOM procedures). Discharge was within 24 h of the procedure in 21 patients, within 1 week in 9 and after 1 week in 6, in 4 of whom the pain was felt to be functional, (range 0–36 days, mean 4, median 1). One patient needed HDU care and one NJ feeding. In 13 of the 36 procedures a prophylactic pancreatic duct (PD) stent was placed. Of 16/29 patients who were contactable by phone for long-term follow-up (average 280 days, SD 142 days), 9 (82%) out of 11 who had sphincterotomy described a sustained symptomatic improvement. Only 2 (40%) out of 5 with no sphincterotomy reported an improvement. <h3>Conclusion</h3> Over half (56%) of patients having SOM had SOD indicating appropriate patient selection. The pancreatitis rate for SOM was 10 times that of all other ERCP in our unit but in keeping with published series.23 The in-house equipment was effective and allowed the service to be delivered without commercial costs. Sphincterotomy provided long-term benefit to over 80% of patients. The service will be further developed in light of these findings, with earlier discharge of patients with functional post-procedure pain and an increase in PD stent placement rate.