Sphincter of Oddi disfunction in "idiopathic" recurrent pancreatitis

Abstract

As the pathogenesis of acute recurrent pancreatitis remains unclear in 30% of patients, it was the aim of this study to find out whether and how often changes in sphincter of Oddi motility is present in these patients and whether endoscopic treatment promises success. 18 patients (three men, 15 women; mean age 41.5 [30-56] years) with "idiopathic" acute recurrent pancreatitis seen consecutively between April 1991 and November 1995, were included in the study. In none had laboratory examinations, sonography, computed tomography and endosonography (n = 11) demonstrated any unusual findings. Neither exocrine (pancreaolauryl test in 8, secretin-pancreozymin test in 10 patients), nor endocrine (oral glucose tolerance test) pancreatic insufficiency had been found. Endoscopic retrograde cholangiopancreatography had excluded morphological changes in the biliary-pancreatic system. All patients underwent endoscopic manometry. When a basal sphincter of Oddi pressure > or = 40 mm Hg was demonstrated in the pancreatic sphincter segment, combined endoscopic sphincterotomy was done of both the biliary and the pancreatic component. Nine patients had a raised basal sphincter pressure in the pancreatic segment of the sphincter, but in only four in the biliary one as well. The phasic sphincter motility was normal in all patients. In four patients iatrogenic pancreatitis developed after the procedure (mild in three, moderately severe in one). Eight of the nine patients who had a sphincterotomy remained symptom-free during a mean follow-up period of 21 months, but only three of the nine with normal manometric findings. Half of the patients with acute recurrent pancreatitis of unknown cause have sphincter of Oddi dysfunction, usually limited to the pancreatic segment of the sphincter, Endoscopic sphincterotomy can prevent recurrent pancreatitis in most of the patients.