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 1993-6, SOM was successfully performed on both the pancreatic and bile ducts in 593 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: ABNORMAL BASAL SPHINCTER PRESSURE (%) Prior Sphincter Therapy Pancreas Alone Biliary Alone Both Total Yes (n=232) 87 (37%) 1 (.5%) 20 (9%) 108 (47%) No (n=360) 68 (19%) 41 (11%) 113(31%) 222 (62%) SUMMARY: 1) Basal sphincter pressure abnormalities are present at SOM in more than one-half of thoroughly studied patients in our ERCP unit. 2) Concordance between biliary and pancreatic (both normal or abnormal) basal sphincter pressure for previously untreated patients was 70%. 3) 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