Sphincter of Oddi dysfunction (SOD): Needle-knife pancreatobiliary sphincterotomy over pancreatic stent (NKOPS) has a lower post-procedure pancreatitis rate than pull-type biliary sphincterotomy (BES)

Stuart Sherman, D. Eversman, Evan Fogel, K. Gottlieb, D. Earle

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Abstract

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 unablated (and may cause transient edema to aggravate pancreatic sphincter pressure elevation). NKOPS may therefore be safer. METHODS: The ERCP database was queried for 1994-6 patients with successful double duct sphincter of Oddi manometry (SOM) who underwent BES or NKOPS. The endoscopist decided on the technique to be used There was a general trend to do NKOPS in 1995-96. Pancreatitis was defined according to Cotton, et al (GI Endosc 1991;37:383). Manometry was performed with an aspirating catheter and mean basal sphincter pressure greater than 40 mmHg was considered abnormal. RESULTS: Post ERCP Pancreatitis Rate Basal SOM Pressure: ↑Biliary ↑Pancreas ↑Both All Pts. Therapy NKOPS (n= 133) 12.5% 14.5% 14.8% 14.3%* BES (n= 163) 35% 20% 24% 27%* *p =.008 For NKOPS, pancreatitis was mild in 10.5%, moderate in 3%, and severe in 8%. For BES, pancreatitis was mild in 16.6%, moderate in 6.1%, and severe in 4.3%. For NKOPS, the frequency of moderate and severe pancreatitis was 3.8% vs. 10.4% (p = .03) for BES. SUMMARY: 1) NKOPS significantly decreased the frequency and severity of post-ES pancreatitis in this high risk treatment group. 2) Patients with elevated pancreatic basal sphincter pressure did not have higher pancreatitis rates than elevated biliary sphincter patients. CONCLUSION: These results need confirmation in other large centers before we recommend general use.

Original languageEnglish
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997

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Sphincter of Oddi Dysfunction
Pancreatitis
Needles
Stents
Manometry
Pressure
Sphincter of Oddi
Endoscopic Retrograde Cholangiopancreatography
BES
Pancreas
Edema
Catheters
Databases

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{8beaa23ce04d405090338ea8b1925c93,
title = "Sphincter of Oddi dysfunction (SOD): Needle-knife pancreatobiliary sphincterotomy over pancreatic stent (NKOPS) has a lower post-procedure pancreatitis rate than pull-type biliary sphincterotomy (BES)",
abstract = "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 unablated (and may cause transient edema to aggravate pancreatic sphincter pressure elevation). NKOPS may therefore be safer. METHODS: The ERCP database was queried for 1994-6 patients with successful double duct sphincter of Oddi manometry (SOM) who underwent BES or NKOPS. The endoscopist decided on the technique to be used There was a general trend to do NKOPS in 1995-96. Pancreatitis was defined according to Cotton, et al (GI Endosc 1991;37:383). Manometry was performed with an aspirating catheter and mean basal sphincter pressure greater than 40 mmHg was considered abnormal. RESULTS: Post ERCP Pancreatitis Rate Basal SOM Pressure: ↑Biliary ↑Pancreas ↑Both All Pts. Therapy NKOPS (n= 133) 12.5{\%} 14.5{\%} 14.8{\%} 14.3{\%}* BES (n= 163) 35{\%} 20{\%} 24{\%} 27{\%}* *p =.008 For NKOPS, pancreatitis was mild in 10.5{\%}, moderate in 3{\%}, and severe in 8{\%}. For BES, pancreatitis was mild in 16.6{\%}, moderate in 6.1{\%}, and severe in 4.3{\%}. For NKOPS, the frequency of moderate and severe pancreatitis was 3.8{\%} vs. 10.4{\%} (p = .03) for BES. SUMMARY: 1) NKOPS significantly decreased the frequency and severity of post-ES pancreatitis in this high risk treatment group. 2) Patients with elevated pancreatic basal sphincter pressure did not have higher pancreatitis rates than elevated biliary sphincter patients. CONCLUSION: These results need confirmation in other large centers before we recommend general use.",
author = "Stuart Sherman and D. Eversman and Evan Fogel and K. Gottlieb and D. Earle",
year = "1997",
language = "English",
volume = "45",
journal = "Gastrointestinal Endoscopy",
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TY - JOUR

T1 - Sphincter of Oddi dysfunction (SOD)

T2 - Needle-knife pancreatobiliary sphincterotomy over pancreatic stent (NKOPS) has a lower post-procedure pancreatitis rate than pull-type biliary sphincterotomy (BES)

AU - Sherman, Stuart

AU - Eversman, D.

AU - Fogel, Evan

AU - Gottlieb, K.

AU - Earle, D.

PY - 1997

Y1 - 1997

N2 - 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 unablated (and may cause transient edema to aggravate pancreatic sphincter pressure elevation). NKOPS may therefore be safer. METHODS: The ERCP database was queried for 1994-6 patients with successful double duct sphincter of Oddi manometry (SOM) who underwent BES or NKOPS. The endoscopist decided on the technique to be used There was a general trend to do NKOPS in 1995-96. Pancreatitis was defined according to Cotton, et al (GI Endosc 1991;37:383). Manometry was performed with an aspirating catheter and mean basal sphincter pressure greater than 40 mmHg was considered abnormal. RESULTS: Post ERCP Pancreatitis Rate Basal SOM Pressure: ↑Biliary ↑Pancreas ↑Both All Pts. Therapy NKOPS (n= 133) 12.5% 14.5% 14.8% 14.3%* BES (n= 163) 35% 20% 24% 27%* *p =.008 For NKOPS, pancreatitis was mild in 10.5%, moderate in 3%, and severe in 8%. For BES, pancreatitis was mild in 16.6%, moderate in 6.1%, and severe in 4.3%. For NKOPS, the frequency of moderate and severe pancreatitis was 3.8% vs. 10.4% (p = .03) for BES. SUMMARY: 1) NKOPS significantly decreased the frequency and severity of post-ES pancreatitis in this high risk treatment group. 2) Patients with elevated pancreatic basal sphincter pressure did not have higher pancreatitis rates than elevated biliary sphincter patients. CONCLUSION: These results need confirmation in other large centers before we recommend general use.

AB - 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 unablated (and may cause transient edema to aggravate pancreatic sphincter pressure elevation). NKOPS may therefore be safer. METHODS: The ERCP database was queried for 1994-6 patients with successful double duct sphincter of Oddi manometry (SOM) who underwent BES or NKOPS. The endoscopist decided on the technique to be used There was a general trend to do NKOPS in 1995-96. Pancreatitis was defined according to Cotton, et al (GI Endosc 1991;37:383). Manometry was performed with an aspirating catheter and mean basal sphincter pressure greater than 40 mmHg was considered abnormal. RESULTS: Post ERCP Pancreatitis Rate Basal SOM Pressure: ↑Biliary ↑Pancreas ↑Both All Pts. Therapy NKOPS (n= 133) 12.5% 14.5% 14.8% 14.3%* BES (n= 163) 35% 20% 24% 27%* *p =.008 For NKOPS, pancreatitis was mild in 10.5%, moderate in 3%, and severe in 8%. For BES, pancreatitis was mild in 16.6%, moderate in 6.1%, and severe in 4.3%. For NKOPS, the frequency of moderate and severe pancreatitis was 3.8% vs. 10.4% (p = .03) for BES. SUMMARY: 1) NKOPS significantly decreased the frequency and severity of post-ES pancreatitis in this high risk treatment group. 2) Patients with elevated pancreatic basal sphincter pressure did not have higher pancreatitis rates than elevated biliary sphincter patients. CONCLUSION: These results need confirmation in other large centers before we recommend general use.

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