Sphincter of Oddi dysfunction (SOD): Combined pancreatobiliary therapy (PBRx) has a lower post-procedure pancreatitis rate than pull-type biliary sphincterotomy (BES)

D. Eversman, E. Fogel, K. Gottlieb, S. Sherman, G. Lehman

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Suspected or documented SOD patients undergoing standard biliary sphincterotomy have high post-procedure pancreatitis rates. Approximately 3/4 of SOD patients have elevated pancreatic sphincter basal pressures. Biliary sphincterotomy (BES) alone leaves the pancreatic sphincter unahlated and may cause transient edema to aggravate pancreatic sphincter pressure elevation. PBRx may therefore be safer. METHODS: The ERCP database was queried for patients with successful double-duct sphincter of Oddi manometry (SOM) who underwent BES or PBRx in 1994-7. The endoscopist decided on the technique to be used. There was a general trend to do PBRx from 1995-7. Pancreatitis was defined according to Cotton, et al (GI Endosc 1991;37:3830). RESULTS: Post-ERCP Pancreatitis Rate Therapy Total Mild Mod Severe None (n=223)*12.1% 5.3% 3.8% .8% NKOPS (n=131)**12.9% a 6.6% 2.3% c 1.2 c BES + PES + Stent (n=78)**16.8% 12.9% 3.9% c 0% c BES (n=184)**28.3% b 15.8% 6.5% d 4.3% d*Manometry normal;**Manometry abnormal a vs. b p<.001; c vs. d (combined moderate/severe) p<.05 NKOPS = needle-knife over pancreatic stent PES = pancreatic sphincterotomy by pull technique SUMMARY: 1) PBRx significantly decreased the frequency and severity of post-ES pancreatitis in this high risk treatment group. 2) Needle-knife over pancreatic stent technique decreased pancreatitis rates down to no therapy group frequency. CONCLUSION: In suspected SOD patients, post-ERCP pancreatitis rates remain high but have improved with addition of combined pancreatic and biliary sphincter therapy.

Original languageEnglish (US)
Pages (from-to)AB113
JournalGastrointestinal endoscopy
Volume47
Issue number4
StatePublished - Dec 1 1998

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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