Sphincter of Oddi dysfunction can be fully classified and detected only if both the pancreatic and biliary portions of the sphincter are simultaneously studied. METHODS: From 1993-5, SOM was successfully performed on both the pancreatic and bile ducts in 463 patients who had idiopathic pancreatitis or pain suggestive of a pancreatobiliary origin. One to three station pull throughs were done in each duct using the Wilson-Cook aspirating triple lumen catheter perfused at .25 ml/min/lumen. The basal sphincter pressure was determined for each lead and averaged for all pull throughs for that duct. A basal sphincter pressure ≥ 40 mmHg was considered abnormal. Phasic waves were not tallied RESULTS: PTS. WITH ABNORMAL BASAL SPHINCTER FRESSURE (%) Prior Sphincter Therapy Pancreas Alone Biliary Alone Both Total Yes (n=183) 72 (39%) 2 (1%) 16 (9%) 90 (49%) No (n=280) 52 (19%) 25 (9%) 76 (27%) 153 (55%) SUMMARY: 1) Basal sphincter pressure abnormalities are present at SOM in approximately one half of thoroughly studied patients in our ERCP unit. 2) Among the 153 previously untreated patients with an abnormal basal pressure, 76 (50%) had elevation of both the biliary and pancreatic sphincter segments. 3) Concordance between biliary and pancreatic (both normal or abnormal) basal sphincter pressure for previously untreated patients was 73%. 4) After biliary sphincterotomy, symptomatic patients have a high frequency of pancreatic basal sphincter abnormalities. CONCLUSION: Both pancreatic and biliary portions of the sphincter of Oddi must be evaluated to fully define sphincter dysfunction.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging