BACKGROUND: Sphincter of Oddi dysfunction (SOD) may be an etiologic factor in some patients with idiopathic pancreatitis (IP). Our aim was to review the frequency of abnormal biliary and pancreatic basal sphincter pressure at sphincter of Oddi manometry (SOM) in patients with this clinical diagnosis. METHODS: 108 IP patients with a normal pancreatogram underwent double-duct (biliary and pancreatic) SOM using a triple-lumen water-perfused catheter with 1 lumen used for aspiration; pressures were measured by station pull-through SOD was diagnosed when the basal sphincter pressure was ≥ 40mm Hg. Patients with recurrent pancreatitis (RP) with ≥ 2x elevation of amylase/lipase on ≥ 2 occasions, a dilated pancreatic duct, and delayed drainage time at ERCP were classified as Pancreas type (P) I. Type II patients had pancreatic pain or RP, and 1 of the previous abnormalities. Type III patients included those with pancreatic pain alone. RESULTS: (i) Fifty of 108 patients had received no prior sphincter therapy. Of these, 48 (96%) were P-II. Nineteen of the 50 patients (38%) had both B and P sphincter pressures elevated, 16 (32%) had one hypertensive sphincter (12 P, 4 B), and 15 (30%) had normal SOM. (ii) Thirty-seven patients had received prior B sphincter therapy but no P therapy. Thirty-six (97%) were classified as P-II. Overall, 4/37 (11%) had persistently elevated B sphincter pressure, in association with elevated P sphincter pressure. Of the remaining 33 patients, 19 had elevated P sphincter pressure alone, while 14 had normal SOM. (iii) Twenty-one of the 108 patients had prior dual (B and P) sphincterotomy. Of these, 16 (76%) were P-II. In this last group, 86% (18/21) had normal SOM and 14% (3/21) had isolated elevations of P sphincter pressure. No patients had residual elevated B pressures. SUMMARY: In our series of IP patients undergoing SOM, 56% (61/108) had SOD: 70%, 62% and 14% in patients with intact sphincters, B sphincterotomy and dual sphincterotomy, respectively. CONCLUSION: SOM is indicated in the workup of IP, as SOD is frequently diagnosed. Residual pancreatic sphincter hypertension is common after biliary sphincterotomy alone. Trials comparing biliary versus combined biliary and pancreatic sphincterotomy in idiopathic pancreatitis secondary to SOD are awaited.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging