Utility of sphincter of Oddi manometry (SOM) in chronic pancreatitis (CP)

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Abstract

BACKGROUND: Sphincter of Oddi dysfunction (SOD) may play a causal role in acute pancreatitis, but its relationship with CP is unclear. In 20% of CP cases, no cause is identified. Our goal was to review the frequency of SOD in patients with CP. METHODS: A diagnosis of CP was made in 102 patients based on clinical history, CT findings and ERCP. All patients underwent double-duct (biliary and pancreatic) SOM using a triple-lumen water-perfused catheter with I lumen used for aspiration; pressures were measured by station pull-through. SOD was diagnosed when the basal sphincter pressure was ≥ 40mm Hg. Patients were classified as Pancreas type (P) I, II, III according to the Sherman-Lehman classification (Am J Castro 1991;86:586). RESULTS: (i) 47 of 102 patients had received no prior sphincter therapy. The majority of these patients were P-II (35/47; 74%). Overall, 14/47 (30%) had elevations of both B and P pressures, 13 (28%) had isolated elevations of 1 sphincter only (8 P, 5 B), and 20 (43%) had normal SOM. (ii) A prior biliary sphincterotomy alone was found in 37 patients. Twenty-eight (76%) were P-II. Seven of the 37 patients (19%) had persistently high B pressures, in association with elevated P pressures. Of the remaining 30 patients, 16 (43%) had elevated P pressure alone and 14 (38%) had normal SOM. (iii) Nineteen of the 102 patients had prior dual (B and P) sphincter therapy. Of these, 14 (74%) were P-II. No patients had residual elevated B pressures, with only 1 patient (5%) demonstrating elevated P pressures. In the entire group of 102 patients, the frequency of SOD in mild CP was 62% (40/65), moderate CP 27% (6/22), and severe CP 27% (4/15). SUMMARY: In our series of CP pts undergoing SOM, 49% (50/102) had evidence of SOD: 57%, 62% and 5% in pts with intact sphincters, B sphincterotomy and dual sphincterotomy, respectively. The frequency of SOD in CP is similar to that seen in our referral population without CP. CONCLUSION: SOD is a frequent finding in pts with CP. Further trials are needed to determine whether (1) SOD causes CP or results from the generalized scarring process, and (2) biliary or dual sphincterotomy will alter the course of this disease in patients with SOD.

Original languageEnglish
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997

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Sphincter of Oddi
Manometry
Chronic Pancreatitis
Sphincter of Oddi Dysfunction
Pressure
Endoscopic Retrograde Cholangiopancreatography
Pancreatic Ducts

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Utility of sphincter of Oddi manometry (SOM) in chronic pancreatitis (CP). / Fogel, Evan; Eversman, D.; Sherman, Stuart; Lehman, Glen.

In: Gastrointestinal Endoscopy, Vol. 45, No. 4, 1997.

Research output: Contribution to journalArticle

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title = "Utility of sphincter of Oddi manometry (SOM) in chronic pancreatitis (CP)",
abstract = "BACKGROUND: Sphincter of Oddi dysfunction (SOD) may play a causal role in acute pancreatitis, but its relationship with CP is unclear. In 20{\%} of CP cases, no cause is identified. Our goal was to review the frequency of SOD in patients with CP. METHODS: A diagnosis of CP was made in 102 patients based on clinical history, CT findings and ERCP. All patients underwent double-duct (biliary and pancreatic) SOM using a triple-lumen water-perfused catheter with I lumen used for aspiration; pressures were measured by station pull-through. SOD was diagnosed when the basal sphincter pressure was ≥ 40mm Hg. Patients were classified as Pancreas type (P) I, II, III according to the Sherman-Lehman classification (Am J Castro 1991;86:586). RESULTS: (i) 47 of 102 patients had received no prior sphincter therapy. The majority of these patients were P-II (35/47; 74{\%}). Overall, 14/47 (30{\%}) had elevations of both B and P pressures, 13 (28{\%}) had isolated elevations of 1 sphincter only (8 P, 5 B), and 20 (43{\%}) had normal SOM. (ii) A prior biliary sphincterotomy alone was found in 37 patients. Twenty-eight (76{\%}) were P-II. Seven of the 37 patients (19{\%}) had persistently high B pressures, in association with elevated P pressures. Of the remaining 30 patients, 16 (43{\%}) had elevated P pressure alone and 14 (38{\%}) had normal SOM. (iii) Nineteen of the 102 patients had prior dual (B and P) sphincter therapy. Of these, 14 (74{\%}) were P-II. No patients had residual elevated B pressures, with only 1 patient (5{\%}) demonstrating elevated P pressures. In the entire group of 102 patients, the frequency of SOD in mild CP was 62{\%} (40/65), moderate CP 27{\%} (6/22), and severe CP 27{\%} (4/15). SUMMARY: In our series of CP pts undergoing SOM, 49{\%} (50/102) had evidence of SOD: 57{\%}, 62{\%} and 5{\%} in pts with intact sphincters, B sphincterotomy and dual sphincterotomy, respectively. The frequency of SOD in CP is similar to that seen in our referral population without CP. CONCLUSION: SOD is a frequent finding in pts with CP. Further trials are needed to determine whether (1) SOD causes CP or results from the generalized scarring process, and (2) biliary or dual sphincterotomy will alter the course of this disease in patients with SOD.",
author = "Evan Fogel and D. Eversman and Stuart Sherman and Glen Lehman",
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T1 - Utility of sphincter of Oddi manometry (SOM) in chronic pancreatitis (CP)

AU - Fogel, Evan

AU - Eversman, D.

AU - Sherman, Stuart

AU - Lehman, Glen

PY - 1997

Y1 - 1997

N2 - BACKGROUND: Sphincter of Oddi dysfunction (SOD) may play a causal role in acute pancreatitis, but its relationship with CP is unclear. In 20% of CP cases, no cause is identified. Our goal was to review the frequency of SOD in patients with CP. METHODS: A diagnosis of CP was made in 102 patients based on clinical history, CT findings and ERCP. All patients underwent double-duct (biliary and pancreatic) SOM using a triple-lumen water-perfused catheter with I lumen used for aspiration; pressures were measured by station pull-through. SOD was diagnosed when the basal sphincter pressure was ≥ 40mm Hg. Patients were classified as Pancreas type (P) I, II, III according to the Sherman-Lehman classification (Am J Castro 1991;86:586). RESULTS: (i) 47 of 102 patients had received no prior sphincter therapy. The majority of these patients were P-II (35/47; 74%). Overall, 14/47 (30%) had elevations of both B and P pressures, 13 (28%) had isolated elevations of 1 sphincter only (8 P, 5 B), and 20 (43%) had normal SOM. (ii) A prior biliary sphincterotomy alone was found in 37 patients. Twenty-eight (76%) were P-II. Seven of the 37 patients (19%) had persistently high B pressures, in association with elevated P pressures. Of the remaining 30 patients, 16 (43%) had elevated P pressure alone and 14 (38%) had normal SOM. (iii) Nineteen of the 102 patients had prior dual (B and P) sphincter therapy. Of these, 14 (74%) were P-II. No patients had residual elevated B pressures, with only 1 patient (5%) demonstrating elevated P pressures. In the entire group of 102 patients, the frequency of SOD in mild CP was 62% (40/65), moderate CP 27% (6/22), and severe CP 27% (4/15). SUMMARY: In our series of CP pts undergoing SOM, 49% (50/102) had evidence of SOD: 57%, 62% and 5% in pts with intact sphincters, B sphincterotomy and dual sphincterotomy, respectively. The frequency of SOD in CP is similar to that seen in our referral population without CP. CONCLUSION: SOD is a frequent finding in pts with CP. Further trials are needed to determine whether (1) SOD causes CP or results from the generalized scarring process, and (2) biliary or dual sphincterotomy will alter the course of this disease in patients with SOD.

AB - BACKGROUND: Sphincter of Oddi dysfunction (SOD) may play a causal role in acute pancreatitis, but its relationship with CP is unclear. In 20% of CP cases, no cause is identified. Our goal was to review the frequency of SOD in patients with CP. METHODS: A diagnosis of CP was made in 102 patients based on clinical history, CT findings and ERCP. All patients underwent double-duct (biliary and pancreatic) SOM using a triple-lumen water-perfused catheter with I lumen used for aspiration; pressures were measured by station pull-through. SOD was diagnosed when the basal sphincter pressure was ≥ 40mm Hg. Patients were classified as Pancreas type (P) I, II, III according to the Sherman-Lehman classification (Am J Castro 1991;86:586). RESULTS: (i) 47 of 102 patients had received no prior sphincter therapy. The majority of these patients were P-II (35/47; 74%). Overall, 14/47 (30%) had elevations of both B and P pressures, 13 (28%) had isolated elevations of 1 sphincter only (8 P, 5 B), and 20 (43%) had normal SOM. (ii) A prior biliary sphincterotomy alone was found in 37 patients. Twenty-eight (76%) were P-II. Seven of the 37 patients (19%) had persistently high B pressures, in association with elevated P pressures. Of the remaining 30 patients, 16 (43%) had elevated P pressure alone and 14 (38%) had normal SOM. (iii) Nineteen of the 102 patients had prior dual (B and P) sphincter therapy. Of these, 14 (74%) were P-II. No patients had residual elevated B pressures, with only 1 patient (5%) demonstrating elevated P pressures. In the entire group of 102 patients, the frequency of SOD in mild CP was 62% (40/65), moderate CP 27% (6/22), and severe CP 27% (4/15). SUMMARY: In our series of CP pts undergoing SOM, 49% (50/102) had evidence of SOD: 57%, 62% and 5% in pts with intact sphincters, B sphincterotomy and dual sphincterotomy, respectively. The frequency of SOD in CP is similar to that seen in our referral population without CP. CONCLUSION: SOD is a frequent finding in pts with CP. Further trials are needed to determine whether (1) SOD causes CP or results from the generalized scarring process, and (2) biliary or dual sphincterotomy will alter the course of this disease in patients with SOD.

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VL - 45

JO - Gastrointestinal Endoscopy

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