This paper is only available as a PDF. To read, Please Download here.
Background: For patients with sphincter of Oddi dysfunction and abnormal pancreatic basal sphincter pressure, additional pancreatic sphincterotomy has been recommended. The outcome of endoscopic dual pancreatobiliary sphincteretomy in patients with manometry-documented sphincter of Oddi dysfunction was evaluated.
Methods: An ERCP database was searched for data entered from January 1995 to November 2000 on patients with sphincter of Oddi dysfunction who met the following parameters: sphincter of Oddi manometry of both ducts, abnormal pressure for at least 1 sphincter (≥40 mm Hg), no evidence of chronic pancreatitis, and endoscopic dual pancreatobiliary sphincterotomy. Patients were offered reintervention by repeat ERCP if clinical symptoms were not improved. The frequency of reintervention was analyzed according to ducts with abnormal basal sphincter pressure, previous cholecystectomy, sphincter of Oddi dysfunction type, and endoscopic dual pancreatobiliary sphincterotomy method.
Results: A total of 313 patients were followed for a mean of 43.1 months (median, 41.0 months; interquartile range: 29.8–60.0 months). Immediate postendoscopic dual pancreatobiliary sphincterotomy complications occurred in 15% of patients. Reintervention was required in 24.6% of patients at a median follow-up (interquartile range) of 8.0 (5.5–22.5) months. The frequency of reintervention was similar irrespective of ducts with abnormal basal sphincter pressure, previous cholecystectomy, or endoscopic dual pancreatobiliary sphincterotomy method. Of patients with type III sphincter of Oddi dysfunction, 28.3% underwent reintervention compared with 20.4% with combined types I and II sphincter of Oddi dysfunction (p=0.105). When compared with endoscopic biliary sphincterotomy alone in historical control patients from our unit, endoscopic dual pancreatobiliary sphincterotomy had a lower reintervention rate in patients with pancreatic sphincter of Oddi dysfunction alone and a comparable outcome in those with sphincter of Oddi dysfunction of both ducts.
Conclusion: Endoscopic dual pancreatobiliary sphincterotomy is useful in patients with pancreatic sphincter of Oddi dysfunction. Prospective randomized trials of endoscopic biliary sphincterotomy alone versus endoscopic dual pancreatobiliary sphincterotomy based on sphincter of Oddi manometry findings are in progress.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Gastrointestinal Endoscopy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Sphincter of Oddi dysfunction.in: Yamada T Alpers DH Laine L Owyang C Powell DW Textbook of gastroenterology. 3rd ed. Lippincott Williams & Wilkins, Philadelphia1999: 2343-2354
- Does intrabiliary pressure predict basal sphincter of Oddi pressure? A study in patients with and without gallbladders.Gastrointest Endosc. 1996; 44: 696-699
- Pancreatic duct obstruction triggers acute necrotizing pancreatitis in the opossum.Gastroenterology. 1993; 104: 853-861
- The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction.N Engl J Med. 1989; 320: 82-87
- Efficacy of endoscopic sphincterotomy and surgical sphincteroplasty for patients with sphincter of Oddi dysfunction (SOD): randomized, controlled study [abstract].Gastrointest Endosc. 1994; 40: 125
- Ineffectiveness of conventional sphincteroplasty in relieving pancreatic duct sphincter pressure in patients with idiopathic recurrent pancreatitis [abstract].Gastroenterology. 1983; 84: 1189
- Intestinal dysmotility in patients with sphincter of Oddi dysfunction: a reason for failed response to sphincterotomy.Dig Dis Sci. 1994; 39: 1942-1946
- Repeat pancreatic sphincter of Oddi manometry immediately after biliary sphincterotomy [abstract].Am J Gastroenterol. 1996; 91: 1943
- Frequency of abnormal pancreatic and biliary sphincter manometry compared with clinical suspicion of sphincter of Oddi dysfunction.Gastrointest Endosc. 1999; 50: 637-641
- Sphincter of Oddi dysfunction (SOD): long-term outcome of biliary sphincterotomy (BES) correlated with abnormal biliary and pancreatic sphincters [abstract].Gastrointest Endosc. 1999; 49: 78
- Sphincter of Oddi manometry: Is it necessary to measure both biliary and pancreatic sphincter pressure?.Gastrointest Endosc. 2000; 52: 183-186
- Biliary and/or pancreatic sphincter of Oddi dysfunction (SOD): response to endoscopic sphincterotomy (ES) [abstract].Gastrointest Endosc. 1996; 43: 384
- Endoscopic treatment in type II pancreatic sphincter dysfunction [abstract].Gastrointest Endosc. 1995; 41: 398
- What are the long-term results of endoscopic pancreatic sphincterotomy?.Gastrointest Endosc. 2000; 52: 15-19
- Endoscopic pancreatic sphincterotomy: indications, outcome, and a safe stentless technique.Gastrointest Endosc. 1998; 47: 240-249
- Frequency of abnormal sphincter of Oddi manometry compared with the clinical suspicion of sphincter of Oddi dysfunction.Am J Gastroenterol. 1991; 86: 586-590
- Sphincter of Oddi manometry: interobserver variability.Gastrointest Endosc. 1993; 39: 486-491
- Sphincter of Oddi manometry in healthy volunteers.Dig Dis Sci. 1990; 35: 38-46
- Effects of meperidine on the pancreatic and biliary sphincter.Gastrointest Endosc. 1996; 44: 239-242
- Effects of droperidol on the biliary and pancreatic sphincter [abstract].Gastrointest Endosc. 1999; 49: AB78
- Endoscopic sphincterotomy complications and their management: an attempt at consensus.Gastrointest Endosc. 1991; 37: 383-393
- Transduodenal sphincteroplasty with transampullary septectomy for stenosing papillitis.Am J Surg. 1991; 161: 213-218
- Comparison of intraoperative and endoscopic manometry of the sphincter of Oddi.Surg Gynecol Obstet. 1992; 175: 410-418
- Division of the sphincter of Oddi for treatment of dysfunction associated with recurrent pancreatitis.Br J Surg. 1996; 83: 1205-1210
- Complications of endoscopic biliary sphincterotomy.N Engl J Med. 1996; 335: 909-918
- Is pancreatic duct obstruction secondary to pancreatic sphincter hypertension (PSH) the cause of post-ERCP pancreatitis in patients with sphincter of Oddi dysfunction (SOD)? [abstract].Gastrointest Endosc. 1995; 4: 430
- Sphincter of Oddi dysfunction: pancreatobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone.Endoscopy. 2002; 34: 280-285
- Long-term results after endoscopic papillotomy.Endoscopy. 1983; 15: 165-168
- The incidence of post-sphincterotomy stenosis in group II patients with sphincter of Oddi dysfunction.Gastrointest Endosc. 1993; 39: 496-498
- Gastroparesis in patients (PTS) with unex plained biliary colic and suspected sphincter of Oddi dysfunction [abstract].Gastroenterology. 1992; 102: 303
- Biliary dyskinesia with associated high amplitude esophageal peristaltic contractions.Am J Gastroenterol. 1986; 81: 254-256
- Sphincter of Oddi dysfunction is associated with chronic pancreatitis.Am J Gastroenterol. 1997; 92: 1125-1129
- Psychological sphincter of Oddi dysfunction patients [abstract].Am J Gastroenterol. 1990; 85: 1261
- Psychometric profiles of patients with sphincter of Oddi dysfunction (SOD) [abstract].Gastrointest Endosc. 1994; 40: 119
- Visceral algesia in irritable bowel syndrome, fibromyalgia, and sphincter of Oddi dysfunction, type III.Dig Dis Sci. 1999; 44: 631-636
- Postcholecystectomy pain syndrome: pathophysiology of abdominal pain in sphincter of Oddi type III.Gastroenterology. 1999; 116: 900-905
Accepted: December 5, 2002
Received: October 3, 2002
1Presented in part at the annual meeting of the American Society for Gastrointestinal Endoscopy, May 19–23, 2002, San Francisco, California.
© 2003 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.