Endoscopic pancreatic sphincterotomy is gaining application for pancreatic-type sphincter of Oddi dysfunction. The efficacy of this technique has received little evaluation. METHODS: The ERCP database was queried from 1994-96 for patients who underwent both biliary and pancreatic sphincter ablation by endoscopic sphincterotomy or surgical sphincteroplasty techniques for documented or suspected pancreatic sphincter dysfunction and later had follow up manometry. Prior to 1990 these were done surgically but subsequently nearly all were done endoscopically. Endoscopic pancreatic sphincterotomies were done by pull-type sphincterotome or needle-knife over pancreatic stent technique at the choice of the endoscopist. All patients had simultaneous or prior biliary sphincterotomy. All patients re-evaluated by manometry had recurrent/persistent abdominal pain or pancreatitis. Manometry was performed by standard aspirating catheter technique with mean basal sphincter pressure ≥ 40 mm Hg considered abnormal. RESULTS: Prior Elevated Basal Sphincter Pressure Therapy n Pancreas Biliary Both Neither Surgical 27 1(3.7% 0 0 26(96.3%)* Endoscopic 62 16(25.8%) 0 4(6.5%) 42(67.7%)* (*p = .004) SUMMARY: 1. Surgical pancreatic sphincter ablation successfully lowered pancreatic sphincter basal pressure into the normal range in nearly all patients. 2. Endoscopic pancreatic sphincter ablation lowered basal sphincter pressure to < 40 mmHg in 2/3 of cases. CONCLUSION: 1) Endoscopic pancreatic sphincterotomy is less effective than surgical pancreatic sphincteroplasty. 2) The optimal technique for endoscopic pancreatic sphincterotomy needs further study. 3. Manometric studies in post pancreatic sphincterotomy patients who achieve pain relief would be of interest. 4. A detailed chronic pancreatitis evaluation (careful review of pancreatogram, endoscopic ultrasound evaluation of pancreatic parenchyma, secretin stimulated exocrine juice assessment) is recommended for patients with normal follow up manometry but persistent pain.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging