Sphincter Of Oddi Dysfunction Research Articles

Investigation of the mechanisms and experimental verification of Shao yao gan cao decoction against Sphincter of Oddi Dysfunction via systems pharmacology.

This study explored the chemical and pharmacological mechanisms of Shao Yao Gan Cao decoction (SYGC) in the treatment of Sphincter of Oddi Dysfunction (SOD) through ultra-high-performance liquid chromatography coupled with Quadrupole Exactive-Orbitrap high-resolution mass spectrometry (UHPLC-Q Exactive-Orbitrap HR-MS), network pharmacology, transcriptomics, molecular docking and in vivo experiments. First, we identified that SYGC improves SOD in guinea pigs by increased c-kit expression and decreased inflammation infiltration and ring muscle disorders. Then, a total of 649 SOD differential genes were found through RNA sequencing and mainly enriched in complement and coagulation cascades, the B cell receptor signaling pathway and the NF-kappa B signaling pathway. By combining UHPLC-Q-Orbitrap-HRMS with a network pharmacology study, 111 chemicals and a total of 52 common targets were obtained from SYGC in the treatment of SOD, which is also involved in muscle contraction, the B cell receptor signaling pathway and the complement system. Next, 20 intersecting genes were obtained among the PPI network, MCODE and ClusterOne analysis. Then, the molecular docking results indicated that four active compounds (glycycoumarin, licoflavonol, echinatin and homobutein) and three targets (AURKB, KIF11 and PLG) exerted good binding interactions, which are also related to the B cell receptor signaling pathway and the complement system. Finally, animal experiments were conducted to confirm the SYGC therapy effects on SOD and verify the 22 hub genes using RT-qPCR. This study demonstrates that SYGC confers therapeutic effects against an experimental model of SOD via regulating immune response and inflammation, which provides a basis for future research and clinical applications.

Sphincter of Oddi dysfunction with papillary folds diagnosed by capturing mucosal morphological changes via EUS: A case report

Sphincter of Oddi dysfunction with papillary folds diagnosed by capturing mucosal morphological changes via EUS: A case report

Diagnosis and Treatment of Non-Foreign Body-Associated Secondary Dilatation of The Common Bile Duct

Objective: To explore the etiology, diagnosis and treatment of non-foreign body secondary choledochectasis. Methods: The clinical data of 162 cases admitted from January 1994 to December 2021 were retrospectively studied. Results: The causes and diagnosis of non-foreign body secondary dilatation were accurately identified by careful history, physical examination, imaging and laboratory tests into 10 categories: inflammation; sphincter of Oddi dysfunction; post gastric bariatric surgery; compression; compensation; Bile duct injury; duodenal disease; other factors. Conclusion: The etiology of non-foreign body secondary choledochectasis is complex. Effective treatment should be selected according to different etiologies.

Efficacy of Hymecromone in Post-Cholecystectomy Patients

Background. The cholecystectomy is the major cause of sphincter of Oddi dysfunction (SOD), that may be classified as post-cholecystectomy syndrome (PCES). Treatment of PCES requires in most of the cases application of selective antispasmodic drugs.Aim. To evaluate efficacy and safety of hymecromone in patients with post-cholecystectomy SOD, to compare standard and reduced doses of hymecromone.Methods. Overall, 26 patients were enrolled in non-interventional comparative study: 2 males, 24 females, aged from 25 to 74 years. All patients underwent cholecystectomy for symptomatic gallstone disease within 1 to 10 years prior to beginning of the study. All patients were diagnosed to have SOD according to Rome IV Diagnostic Criteria for functional biliary sphincter of Oddi disorder (E1b). All patients underwent hymecromone monotherapy for 3 weeks. Patients were randomized to group A and B to receive full-dose or half-dose of the drug respectively.Results. Abdominal pain completely subsided in 85 % of patients, significant improvement was found for bloating and diarrhea. Mild increase in fasting common bile duct (CBD) diameter after treatment (7.23 ± 0.99 vs 6.78 ± 1.01; p = 0.029) was attributed to choleretic action of hymecromone. Hymecromone resulted in significant improvement of CBD response to fatty meal stimulation (ΔCBD): –1.08 ± 0.46 mm vs –0.10 ± 0.33 mm pretreatment (p = 0.016). Degree of improvement was more pronounced in the group A (full-dose) as compared to group B (half-dose) for abdominal pain (Z = 2.74, p = 0.031), bloating (Z = 2.63, p = 0.035) and constipation (Z = 2.61, p = 0.038)Conclusion. Hymecromone demonstrated itself to be an effective and safe drug, that may be applied both in standard and half dose. However, the efficacy of full-dose is higher both for the treatment of biliary pain and dyspeptic symptoms. Transabdominal ultrasound may be applied as a reliable test for both prediction of treatment efficacy and to monitor patients state during treatment course.

833 An Interesting Association Between Recurrent Acute Pancreatitis and Myotonic Dystrophy, A Case Report

Abstract Myotonic Dystrophy(MD) is an autosomal dominant genetic condition affecting the musculoskeletal system. Recurrent acute pancreatitis(RAP) is a frequent presentation in the emergency surgical scenario with two or more episodes of established acute pancreatitis separated by a minimum of 3 month periods. We report here a case of a patient presenting with a background of Myotonic Dystrophy with a third episode of RAP. Diagnostic work up led to the discovery of microlithiasis as a possible cause of pancreatitis in our patient. Literature review reports two other case reports detailing a potential association between MD and pancreatitis at the time of writing. This could be due to disturbances of the pancreatobiliary system, resulting from the sphincter of Oddi dysfunction (SOD) and gallbladder myotonia as MD affects the smooth and striated muscle of the gastrointestinal tract. In our case report, we highlight the importance of understanding how MD is a rare cause for a common surgical emergency presentation clinicians should be aware of.

S3576 Oddity of an Opiated Oddi: A Case of Sphincter of Oddi Dysfunction

Introduction: We present a case of recurrent right upper quadrant (RUQ) pain resulting from Sphincter of Oddi Dysfunction (SOD) in the setting of chronic opioid use. SOD is a functional gastrointestinal disorder that presents similarly to other disorders of the biliary tree. Understanding features of this disorder and its etiologies can streamline evaluation and treatment. Case Description/Methods: Our patient is a 77-year-old male, chronic opioid user, who had multiple Emergency Department (ED) visits and hospital admissions for RUQ pain in the setting of significantly elevated liver associated enzymes (LAEs). However, repeated imaging of the RUQ with CT, Ultrasound, and MRCP remained largely unremarkable. On a subsequent presentation, the patient experienced severe increase in pain after administration of morphine. Lab investigation showed an abrupt increase in LAEs and lipase after administration of morphine. Imaging was obtained, and was again inconsistent with cholecystitis. Interestingly, he attained analgesia with meperidine on admission. During a following ED visit, RUQ imaging showed non-specific gallbladder inflammation, and a Hepatobiliary Iminodiacetic Acid (HIDA) scan showed low gallbladder ejection fraction (GBEF). These findings suggested Functional Gallbladder Disorder and laparoscopic cholecystectomy was performed. Unfortunately, ten days later the patient had worsening RUQ pain with no signs of obstruction. With diagnostic criteria for SOD met and other etiologies ruled out, our patient was referred for sphincterotomy. Discussion: Opiate-induced SOD is theoretically well known, but there have been only few reported cases in literature. Furthermore, SOD is difficult to diagnose, as providers must first rule out other hepatobiliary disease. ROME IV Diagnostic Criteria for Functional Gastrointestinal Disorders was used in review of our case. Biliary pain, absence of bile duct stones or other structural abnormalities, and elevated LAEs fulfilled the criteria for this disorder. This case highlights the clinical evaluation and care of SOD. While all opioids have been shown to contract the Sphincter of Oddi (SO), morphine has been shown to strongly cause this contraction, and is one of the earliest reported causes of SOD in literature. Meperidine has been shown to have minimal effect on the SO contraction and is the ideal opioid to treat pain of biliary or pancreatic source.

S1018 Rectal NSAIDs Decrease Post-ERCP Pancreatitis (PEP) in Unselected Patients - Comprehensive Meta-Analysis of Randomized Controlled Trials

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is fundamental for treatment of pancreatico-biliary diseases, but results in PEP in up to 15% of patients. Phospholipase A2 (PLA2) is an important factor in the pancreatitis inflammatory cascade and NSAIDs, which inhibit PLA2 activity, prevent PEP in high-risk patients. We endeavored to identify and quantitatively synthesize the existing high-quality data to date on rectal NSAID use for the prevention of post ERCP pancreatitis in unselected patients without specific risk factors for PEP. Methods: In collaboration with a librarian, we searched the following databases: Ovid Medline (coverage 1946 – Present), Embase and Embase Classic (coverage 1947 – Present), Cochrane Library (coverage 1898-present), Web of Science (coverage 1900-present), Clinicaltrials.gov, and Google Scholar through April 2021. Using the Covidence system, two independent reviewers identified randomized controlled studies assessing rectal NSAIDs for PEP prevention in unselected patients. Our primary outcome was odds of developing PEP and our secondary outcome was odds of developing moderately severe or severe PEP. Pooled odds ratios were estimated using the random effects model. Results: After review of 504 abstracts and 234 full text documents, we identified 25 randomized controlled trials evaluating rectal NSAIDs for the prevention of PEP in unselected patients; 4071 patients received rectal NSAIDs and 4005 patients received a placebo. The most frequent NSAID used was diclofenac in 56% of studies, followed by indomethacin in 36%, ketoprofen in 4%, and naproxen in 4%. Unselected patients receiving rectal NSAIDs were less likely to develop PEP (OR 0.59, 95% CI 0.45-0.78) (Figure 1) as well as moderately severe and severe pancreatitis (OR 0.50, 95% CI 0.33-0.75). Conclusion: In unselected patients undergoing ERCP, rectal NSAID administration decreases the risk of post-ERCP pancreatitis and development of moderately severe or severe PEP. They should be considered for unselected patients undergoing ERCP, not simply those high risk for PEP.Figure 1.: Baseline characteristics and clinical outcomes in patients who has ERCP with glucagon (ERCP w glucagon, group 1) compared to individuals ERCP without glucagon (ERCP wo glucagon, group 2) Note: SD-Standard Deviation; € A 1:1 propensity score matching was done based on the following variables: age, gender, race, hypertension, diabetes mellitus, obesity, chronic kidney disease (CKD), Ischemic heart diseases (IHD), chronic obstructive pulmonary disease, indomethacin use, sphincter of Oddi dysfunction (SOD).

S1005 Meta-Analysis and Systematic Review of Pancreatic Stents in Preventing Post-ERCP Pancreatitis

Introduction: Pancreatitis is a common and potentially devastating complication of ERCP. Prior studies have shown that prophylactic pancreatic duct stent (PS) placement may be effective to reduce post-ERCP pancreatitis (PEP) in high-risk patients, such as patients with sphincter of Oddi dysfunction or prior history of pancreatitis. However, prior meta-analyses are missing relevant studies both contemporaneously and since published. We aim to perform a comprehensive analysis comparing PS placement to no PS placement to prevent PEP in high-risk patients. Methods: In conjunction with a health sciences librarian, Ovid Medline, Embase and Embase Classic, Cochrane Library, and Web of Science were searched from inception to March 26, 2021. Randomized controlled trials that directly compared PS placement versus no PS placement in preventing PEP were included. Our primary outcome was the incidence of PEP. Additional outcomes included incidence of mild PEP, moderate PEP, and severe PEP, as well as the incidence of adverse outcomes including hemorrhage, infection, and pancreatic duct perforation. Quantitative data was harmonized using random effects models. Results: The search yielded 1,668 citations, 444 of which were removed as duplicates. Each study was assessed by two reviewers. 116 articles were selected for full text review, and eighteen randomized controlled trials were identified of pancreatic stent placement to prevent post-ERCP pancreatitis. In sum, 1,295 patients were assigned to pancreatic stent prophylaxis and 1,299 to no stent placement. There was a significant reduction in odds of PEP in the PS group (Figure 1, OR 0.36 [95% CI 0.28-0.46]). In addition, PS placement was strongly protective against severe pancreatitis (Table 1, OR 0.25 [95% CI 0.07-0.81]). Stent placement was successful in 98% of cases (95% CI 95-100) and there was no difference in pancreatic duct perforation, bleeding, or infection (Table 1). Conclusion: Pancreatic stent placement is an effective intervention to reduce the incidence of PEP in high-risk patients. Further, pancreatic stent placement is particularly effective against the severe forms of PEP. There is no significant difference in major non-pancreatitis adverse events for pancreatic stent placement compared to no stent placed.Figure 1.: a. Kaplan-Meier (KM) survival curves of time to hospital utilization for inpatients undergoing ERCP, stratified by ASGE 2011 complexity score Figure 1b. Post-hoc analysis of KM survival curve for inpatients undergoing ERCP, ASGE 2011 grade 1 versus 4 Figure 1c. Post-hoc analysis of KM survival curve for inpatients undergoing ERCP, ASGE 2011 grade 2 versus 4 Figure 1d. Post-hoc analysis of KM survival curve for inpatients undergoing ERCP, ASGE 2011 grade 3 versus 4.Table 1.: Odds Ratio of Major Outcomes With Pancreatic Stent Placement ERCP = endoscopic retrograde cholangiopancreatography, PS = pancreatic duct stent, OR = odds ratio, CI = confidence interval.

Доцільність корекції латентного дефіциту заліза в лікуванні школярів із дисфункцією жовчного міхура та сфінктера Одді

Актуальність. Дефіцит заліза (ДЗ) залишається значно поширеним станом серед дітей в Україні. ДЗ сприяє обтяженню перебігу патології шлунково-кишкового тракту в дітей і підлітків, проте вплив корекції латентного ДЗ на перебіг дисфункції жовчних шляхів на сьогодні не вивчений. Мета: визначити вплив корекції латентного ДЗ на клінічний перебіг дисфункції жовчного міхура і сфінктера Одді (ДЖМіСО) і стан обміну заліза в дітей шкільного віку. Матеріали та методи. Проведено дослідження «випадок — контроль», що включало 60 дітей 9–17 років, які проходили стаціонарне лікування з приводу загострення ДЖМіСО і мали латентний ДЗ. Діти були розділені на 2 групи: I — 30 пацієнтів, які отримували препарати заліза (50 мг елементарного заліза) щодня протягом 125 днів; II — 30 дітей, які не отримували препарат заліза. Проведено вивчення анамнезу, клінічне обстеження, загальний аналіз крові, розрахунок коефіцієнта насичення трансферину, визначено вміст сироваткового заліза, мікроелементів у волоссі, проведено спостереження протягом наступних 12 місяців. Результати. Дослідження показало, що застосування препарату заліза в дітей із ДЖМіСО і латентним ДЗ не тільки компенсує в них ДЗ, але й полегшує перебіг ДЖМіСО, знижуючи частоту загострень на 30,7 %. Висновки. Корекція латентного ДЗ із застосуванням препарату глюконату заліза, міді та марганцю полегшує клінічний перебіг ДЖМіСО і покращує стан обміну заліза в школярів.

Клиническое течение и распространенность ожирения в сочетании с дисфункцией сфинктера Одди по панкреатическому типу у подростков

Актуальность. Гастроэнтерологические проявления ожирения являются актуальной проблемой медицины вследствие взаимоотягощающего характера. Цель работы: изучить распространенность и клинические особенности течения у подростков с алиментарно-конституциональным ожирением и сопутствующей дисфункцией сфинктера Одди по панкреатическому типу и без данного сочетания. Материалы и методы. Обследованы 120 подростков с алиментарно-конституциональным ожирением в сочетании с дисфункцией сфинктера Одди по панкреатическому типу, которые находились на лечении в областной детской клинической больнице г. Ивано-Франковска за период с 2016 по 2019 год включительно. Больные подлежали комплексному обследованию в соответствии с современными протоколами диагностики и лечения. Результаты. Распространенность ожирения по Украине, по данным статистики, составляла 13,4 % на 1000 детского населения. Среди пациентов преобладали мальчики (70,0 и 30,0 %, р < 0,05). Продолжительность болезни у большинства детей с сочетанной патологией составила 6,0 ± 2,1 года, а в случае изолированного течения заболевания — 4,5 ± 3,1 года. К доминирующим факторам риска вовлечения поджелудочной железы в патологический процесс относились: генетическая предрасположенность (наличие ожирения или избыточной массы тела у одного или двух родителей), гиподинамия и нарушение рациона питания (преобладание мучных изделий и сладостей), реже — недостаточный питьевой режим. Среди клинических проявлений сочетанной патологии доминировала спастическая боль с локализацией в левом подреберье и продолжительностью несколько часов, которая плохо снималась спазмолитиками (75,0 и 25,0 %, c2 = 17,69, р < 0,05). Общий диспептический индекс (вздутие живота и понос) у детей с сочетанной патологией был выше, чем у остальных обследованных (5,01 ± 0,06 и 3,02 ± 0,04 балла, р < 0,05). Интоксикационный индекс за счет общей слабости был самым высоким в когорте детей с алиментарно-конституциональным ожирением и функциональным панкреатическим расстройством (7,02 ± 0,06 и 3,50 ± 0,02 балла, р < 0,05). Выводы. Ожирение часто сочетается с функциональной патологией поджелудочной железы, а отдельные клинико-лабораторные маркеры и факторы риска вовлечения поджелудочной железы в патологический процесс должны лечь в основу обновленных протоколов диагностики и лечения.

The Effect of Shaoyao Gancao Decoction on Sphincter of Oddi Dysfunction in Hypercholesterolemic Rabbits via Protecting the Enteric Nervous System-Interstitial Cells of Cajal-Smooth Muscle Cells Network.

ObjectiveThis study observes the morphological changes in the enteric nervous system (ENS) – interstitial cells of Cajal (ICC) – smooth muscle cells (SMC) network in sphincter of Oddi dysfunction (SOD) in hypercholesterolemic rabbits following treatment with Shaoyao Gancao decoction (SGD), as well as the apoptosis of the ICC.MethodsIn this study, 48 healthy adult New Zealand rabbits are randomly divided into three groups (n = 16 in each group): the control, the model, and the SGD treatment groups. The hypercholesterolemic rabbit model is established. Hematoxylin and eosin staining, transmission electron microscopy, immunofluorescence, terminal deoxynucleotidyl transferase dUTP nick end labeling staining, immunohistochemistry, Western blot analysis, and reverse transcription-polymerase chain reaction are used to detect the morphological changes in the ENS–ICC–SMC network, the expression of apoptosis-related proteins in the ICC, and to observe the curative effect of SGD after treatment.ResultsCompared with the control group, the morphology and the ultrastructure of the SO are destroyed in the model group. In addition, the protein gene product 9.5 (PGP9.5), nitric oxide (NO), the SMCs, and the ICC all significantly decreased while substance P (SP) significantly increased. Compared with the model group, the SO morphology and ultrastructure are repaired in the SGD group. In addition, the PGP9.5, NO, the SMCs, and the ICC significantly increased while SP decreased. In addition, SGD may activate the stem cell factor (SCF)/c-Kit signaling pathway to treat SO dysfunction by up-regulating the expression of c-Kit and SCF. Similarly, this pathway restores SO by up-regulating the expression of Bcl2 and inhibiting cleaved caspase-3, Bax, and the tumor necrosis factor.ConclusionShaoyao Gancao decoction can promote the recovery of sphincter of Oddi dysfunction in hypercholesterolemic rabbits by protecting the ENS–ICC–SMC network.

Editorial introductions.

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Anthony N. KallooAnthony N. KallooDr Anthony N. Kalloo is Chairman of Medicine at Maimonides Medical Center and Professo Emeritus of Medicine at Johns Hopkins University School of Medicine, USA. He is the former Director of The Division of Gastroenterology and Hepatology at Johns Hopkins Hospital (2005-2020). He has special interests in Natural Orifice Surgery, therapeutic endoscopy, biliary and pancreatic diseases and sphincter of Oddi dysfunction. After receiving his medical degree from the University of West Indies Medical School, West Indies, Dr Kalloo interned and completed his residency in Internal medicine at Howard University Hospital in Washington, D.C., USA. He completed his fellowship training program at the combined Georgetown University, USA, VA Medical Center and NIH program. Prior to joining the faculty at Johns Hopkins in 1988, he was an Instructor in Medicine at Georgetown University. Dr Kalloo is a past Panel Chair for Gastroenterology and Urology Devices with the United States Food and Drug Administration. In 2009 he was recognized as the Distinguished Educator of the Year of the Award by the American Society for Gastrointestinal Endoscopy. In 2014 he received the Endoscopy Award of the German Society of Endoscopy for outstanding Research and contribution in the field of endoscopy. In 2015 he received the BJ Vakil Oration from The Society of GI Endoscopy of India bestowed on an international expert for his contribution to the field of GI Endoscopy. He has over two hundred peer-reviewed publications and over 100 patents. In 2015 he became a member of the inaugural chapter of the National Academy of Inventors at The Johns Hopkins University. This group represents the top 3% of all Faculty inventors since 1969, and the top 1.5% of active Johns Hopkins Faculty. Dhiraj YadavDhiraj YadavDr Yadav is a Professor of Medicine and Associate Chief for Clinical Research and Academic Development in the Division of Gastroenterology, Hepatology and Nutrition at the University of Pittsburgh Medical Center, USA. He has an active clinical practice with a focus on pancreatic diseases. His research interests are in the epidemiology of acute and chronic pancreatitis, and has published several key papers on the epidemiology of pancreatitis, especially its population distributions, the role of alcohol and tobacco in pancreatitis, and the natural history of disease. He is funded by the NIH and the DoD, and is the co-chair of the NIDDK-funded Type 1 diabetes in acute pancreatitis consortium (T1DAPC). He is the co-Principal Investigator on several ongoing multicenter studies, including a longitudinal cohort study of chronic pancreatitis (PROCEED), a randomized clinical trial assessing the role of minor papilla sphincterotomy in recurrent acute pancreatitis and pancreas divisum (SHARP), an observational cohort study on the risk and mechanisms of diabetes in acute pancreatitis (DREAM), and an observational study evaluating the role of short term increase in drinking as a risk factor for pancreatitis (ACCESS-AP). Dr Yadav has over 200 peer reviewed publications and abstract submissions each. He is actively involved in resident and fellow teaching, and co-directs the Enhancing Mentoring to Improve Research in Gastroenterology (EMERGE) program in the Division of Gastroenterology, Hepatology and Nutrition at UPMC. He is a frequent speaker at national and international conferences on acute and chronic pancreatitis.

The Role of Sphincterotomy on the Outcome of Post Endoscopic Retrograde Cholangiopancreatography Pancreatites

Abstract Background: Post-Endoscopic retrograde cholangiopan-creatography [ERCP] pancreatitis is one of the most frequent and feared complications following ERCP and can lead to significant morbidity as well as occasional mortality. Endo-scopic sphincterotomy is a procedure of ERCP that is either used solely for the treatment of diseases of the papilla of Vater, such as sphincter of Oddi dysfunction or to facilitate subsequent therapeutic biliary interventions such as stone extraction or stenting and decrease the possible. Aim of Study: To evaluated the effect of sphinctrotomy in reducing or increasing post ERCP pancreatits. Patients and Methods: A prospective cohort study was conducted in General surgery, Gastro-enterology and Hepa-tology Department Faculty of Medicine, Assiut University Hospital on 100 patients aged from 15 to 70 years from both sexeligible for ERCP for extraction of common bile duct stones, treatment of papillary stenosis and facilitation of endotherapy [i.e. stent placement, tissue sampling and stricture dilation] allocated into 2 equall groups [50 patients each]; group A, in which ERCP was performed with cannulation of the common bile duct and group B in which ERCP was performed with sphincterotomy. Pre-operative assessment included full history, physical examination, serum amylase and lipase and pelvi-abdominal ultrasound. Results: There were no statistically significant differences between both groups as regarding postoperative ultrasound findings and post-operative results of laboratory investigations including: Lipase and amylase. Conclusion: Sphincterotomy can be performed safely and effectively during ERCP without fear of an increased risk of post-ERCP pancreatitis.

Our Experience in Single Center Endoscopic Retrograde Cholangiopancreatography

Amaç: Endoskopik retrograd kolanjiopankreatografi (ERCP), safra yolu ve pankreasın benign ve malign patolojilerinin tanı ve tedavisinde etkin bir biçimde kullanılmaktadır. ERCP bilgi, beceri ve pratik gerektiren kompleks bir uygulamadır. Diğer endoskopik uygulamalardan farklı teknik ve ekipmanın kullanımı ve daha fazla komplikasyon görülmesiyle ayrılır. Bu çalışmadaki amacımız bir genel cerrahi ERCP ünitesinin 19 aylık deneyimini paylaşmaktır. Materyal ve metod: Bu çalışmada15 Mayıs 2019-31Aralık 2020 tarihleri arasında klinik, medikal ve radyolojik verilerde kolestaz, obstruktif kolanjit/pankreatit veya safra kaçağı tanısı konulan ve ERCP işlemi yapılan 513 hastanın verileri retrospektif olarak değerlendirmiştir. Bulgular: Çalışmaya alınan hastaların yaş dağılımı 18-109 arasında ve yaş ortalaması 58,54±20,16 idi. Cinsiyet dağılımı; 356 kadın (%69,4), 157 erkek (%30,6) şeklinde idi. En sık safra yolu tıkanıklığına bağlı kolestaz, tıkanma ikteri, akut pankreatit veya kolanjit tanıları konulmuştu. Bu hastaların 452 si koledok taşı, 15’i pankreas başı tümörü, 11’i koledok tümörü ve 10’u papilla tümörü idi.10 hasta Oddi Sfinkter Disfonksiyonu( ODS) nedeniyle işleme alındı. Safra yolu tıkanılığı ile gelen 499 hastanın 63’ü akut biliyer pankreatit, 38 i akut kolanjit tanılarıyla yatırılmıştı. İşlem süresi 20 dakikayla 90 dakika arasında değişti (ortalama işlem süresi 37 dk). Hastaların ERCP sonrası, 56’sında tedavi gerektirmeyen amilazemi, 24‘ünde ortalama 3 günlük medikal tedaviyle gerileyen pankreatit, 5’inde kan transfüzyonu gerektirmeyen ve adrenalin enjeksiyonu ve balon baskısıyla kontrol edilebilen kanama gelişti. Bir hastada taş ekstraksiyonu sırasında basket ve taş papillada sıkışmıştı. Operatif mortalite olmadı. Sonuç; Safra yollarındaki kaçaklar ve fistüller en iyi ERCP ile gösterilir ve endoskopik olarak tedavi edilir. Etkin olduğu kadar bünyesinde perforasyon, sepsis ve mortalite gibi çok ciddi komplikasyonları barındırdığından endoskopistin uygulamanın endikasyonunu doğru belirlemesi, potansiyel komplikasyonlarını bilmesi ve oluşan komplikasyonları erken bir şekilde tanıması ve tadavisini yönetmesi, komplikasyon yaratacak ve gereksiz uygulamalardan mumkun olduğunca kaçınması gerektiği kanaatindeyiz.

Biliary Tract Malignancies Related to Gallbladder Polyps, Primary Sclerosing Cholangitis, and Choledochal Cysts.

Biliary Tract Malignancies Related to Gallbladder Polyps, Primary Sclerosing Cholangitis, and Choledochal Cysts.

The presence and outcome of biliary sphincter disorders in liver-transplant recipients according to the Rome IV classification.

BackgroundBiliary sphincter disorders after liver transplantation (LT) are poorly described. We aim to describe the presence and outcome of patients with papillary stenosis (PS) and functional biliary sphincter disorders (FBSDs) after LT according to the updated Rome IV criteria.MethodsWe reviewed all endoscopic retrograde cholangiopancreatographies (ERCPs) performed in LT recipients between January 2003 and December 2019. Information on clinical and endoscopic findings was obtained from electronic health records and endoscopy databases. Laboratory and clinical findings were collected at the time of ERCP and 1 month after ERCP.ResultsAmong the 1,307 LT recipients, 336 underwent 849 ERCPs. Thirteen (1.0%) patients met the updated Rome IV criteria for PS [former sphincter of Oddi dysfunction (SOD) type I] and 14 patients (1.0%) met the Rome IV criteria for FBSD (former SOD type II). Biliary sphincterotomy was performed in 13 PS and 10 FBSD cases. One month after sphincterotomy, bilirubin, gamma-glutamyl transferase and alkaline phosphatase levels decreased in 85%, 61%, and 92% of those in the PS group (P = 0.019, 0.087, and 0.003, respectively) and in 50%, 70%, and 80% of those in the FBSD group (P = 0.721, 0.013, and 0.093, respectively). All the 14 patients initially suspected of having a FBSD turned out to have a different diagnosis during the follow-up.ConclusionsPS after LT is uncommon and occurs in only 1% of LT recipients. Our data do not support the presence of an FBSD after LT. Sphincterotomy is a safe and effective procedure in LT recipients with PS.

Dysfunction of Sphincter of Oddi

Sphincter of Oddi Dysfunction (SOD) is a smooth muscle valve disorder regulating the flow of biliary and pancreatic secretions into the duodenum. SOD is categorized into three different types based on the Milwaukee classification system, with a prevalence of 1.5% in the general population. Type I patients have pain as well as abnormal liver enzymes and a dilated common bile duct. Type II SOD consists of pain and only one objective finding, and Type III consists of biliary pain only. The link between SOD and dyslipidemia is underappreciated. Increased biliary absorption of cholesterol in the form of biliary salts can increase the excretion and ultimately result in decreased serum cholesterol levels. It is important to consider SOD in patients with pain, elevated LFT’s and dyslipidemia despite statin therapy. In this article, a case of Type I SOD with recurrent pancreatitis is reviewed. This patient was initially diagnosed with acute pancreatitis secondary to hypertriglyceridemia. He had an additional episode of pancreatitis despite being on statin therapy with an improvement of triglycerides. SOD was then diagnosed with sphincterotomy after his second admission to the hospital. This resulted in the resolution of the patient’s symptoms and improvement of LFT’S. Manometry has long been considered the gold standard for diagnosis; however, it is not always available in low-resource settings. Therefore, endoscopic sphincterotomy is being considered for diagnosis as it can be diagnostic and therapeutic.

ID: 3524324 PREDICTION OF POST-ERCP PANCREATITIS USING POST-PROCEDURE AMYLASE AND LIPASE LEVELS: A SYSTEMATIC REVIEW AND METAANALYSIS

Endoscopic Retrograde Cholangiopancreatography (ERCP) is the mainstay procedure for managing pancreatic and biliary disorders. The most common complication of this procedure is acute pancreatitis, which occurs in 2-10% of the general population. However, Its frequency may go up to 40% in high-risk cases and is endoscopist dependent. Risk factors for post-ERCP pancreatitis (PEP) include young age, female sex, history of pancreatitis, non-dilated bile ducts, sphincter of Oddi dysfunction, etc. Early PEP prediction may allow safe same-day outpatients discharge after ERCP and earlier proper management. This meta-analysis aims to assess the usefulness of post-ERCP evaluation of pancreatic enzymes (lipase and amylase) in predicting PEP.

Characteristics of Patients Undergoing Endoscopic Retrograde Cholangiopancreatography for Sphincter of Oddi Disorders

The concept that sphincter of Oddi dysfunction (SOD) can cause attacks of biliary-type pain in postcholecystectomy patients and those with unexplained recurrent acute pancreatitis, and that endoscopic sphincterotomy can ameliorate symptoms, remains unproven. The Evaluating Predictors and Interventions in Sphincter of Oddi Dysfunction (EPISOD) study of patients without objective evidence for biliary obstruction showed no difference in outcomes between those who underwent sphincterotomy or sham treatment.1 To date, there have been no studies examining the characteristics of patients who still are being offered endoscopic retrograde cholangiopancreatography (ERCP) for SOD since the EPISOD publication, although the absolute number appears to have declined.2.

Secretin-Enhanced MRCP: How and Why-AJR Expert Panel Narrative Review.

Secretin-enhanced MRCP (S-MRCP) has advantages over standard MRCP for imaging of the pancreaticobiliary tree. Through the use of secretin to induce fluid production from the pancreas and leveraging of fluid-sensitive MRCP sequences, S-MRCP facilitates visualization of ductal anatomy, and the findings provide insight into pancreatic function, allowing radiologists to provide additional insight into a range of pancreatic conditions. This narrative review provides detailed information on the practical implementation of S-MRCP, including patient preparation, logistics of secretin administration, and dynamic secretin-enhanced MRCP acquisition. Also discussed are radiologists' interpretation and reporting of S-MRCP examinations, including assessments of dynamic compliance of the main pancreatic duct and of duodenal fluid volume. Established indications for S-MRCP include pancreas divisum, anomalous pancreaticobiliary junction, Santorinicele, Wirsungocele, chronic pancreatitis, main pancreatic duct stenosis, and assessment of complex postoperative anatomy. Equivocal or controversial indications are also described along with an approach to such indications. These indications include acute and recurrent acute pancreatitis, pancreatic exocrine function, sphincter of Oddi dysfunction, and pancreatic neoplasms.