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)

S. Sherman, D. Eversman, E. 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 (US)
Pages (from-to)AB148
JournalGastrointestinal endoscopy
Volume45
Issue number4
DOIs
StatePublished - Jan 1 1997

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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