BACKGROUND: There are few data on combined pancreatic and biliary sphincterotomy for sphincter of Oddi dysfunction (SOD), especially regarding clinical features that might predict outcomes. We sought to examine the relative importance of various clinical features and the presence or absence of objective biliary abnormalities in determining responses to endoscopic therapy. METHODS: A cohort of consecutive patients with suspected SOD was treated with biliary sphincterotomy, with additional pancreatic sphincterotomy at initial or subsequent endoscopic retrograde cholangiopancreatography if there was abnormal pancreatic manometry in conjunction with pain refractory to biliary sphincterotomy, continuous pain, or a history of amylase elevation. Repeat intervention was offered until response was achieved or complete ablation of all treated sphincters was achieved. Response was assessed by patients using a 5-point Likert scale, and multivariate logistic regression analysis used to identify predictors of response. RESULTS: Of 121 patients, 112 (92%) were female, 105 (87%) postcholecystectomy, and by modified Milwaukee biliary classification 18 (15%) were type I, 53 (44%) type II, and 50 (41%) type III. All patients underwent biliary sphincterotomy and 49 (40%) pancreatic sphincterotomy. Good or excellent response at final follow-up was reported by 83 (69%) of 121 patients, including 37 (61%) of 61 patients requiring repeated intervention. Response was not significantly different between biliary types I, II, and III. Patient characteristics (with adjusted odds ratios) that were significant predictors of poor response were normal pancreatic manometry (4.6), delayed gastric emptying (6.0), daily opioid use (4.0), and age <40 (2.7). Abnormal liver function tests or dilated bile duct were not significant. CONCLUSIONS: For the treatment of SOD incorporating pancreatic and biliary sphincterotomy, patient characteristics and pancreatic sphincter manometry may be more important predictors of outcome than the traditional classification based on liver chemistries and bile duct dilation.
BACKGROUND: There are few data on combined pancreatic and biliary sphincterotomy for sphincter of Oddi dysfunction (SOD), especially regarding clinical features that might predict outcomes. We sought to examine the relative importance of various clinical features and the presence or absence of objective biliary abnormalities in determining responses to endoscopic therapy. METHODS: A cohort of consecutive patients with suspected SOD was treated with biliary sphincterotomy, with additional pancreatic sphincterotomy at initial or subsequent endoscopic retrograde cholangiopancreatography if there was abnormal pancreatic manometry in conjunction with pain refractory to biliary sphincterotomy, continuous pain, or a history of amylase elevation. Repeat intervention was offered until response was achieved or complete ablation of all treated sphincters was achieved. Response was assessed by patients using a 5-point Likert scale, and multivariate logistic regression analysis used to identify predictors of response. RESULTS: Of 121 patients, 112 (92%) were female, 105 (87%) postcholecystectomy, and by modified Milwaukee biliary classification 18 (15%) were type I, 53 (44%) type II, and 50 (41%) type III. All patients underwent biliary sphincterotomy and 49 (40%) pancreatic sphincterotomy. Good or excellent response at final follow-up was reported by 83 (69%) of 121 patients, including 37 (61%) of 61 patients requiring repeated intervention. Response was not significantly different between biliary types I, II, and III. Patient characteristics (with adjusted odds ratios) that were significant predictors of poor response were normal pancreatic manometry (4.6), delayed gastric emptying (6.0), daily opioid use (4.0), and age <40 (2.7). Abnormal liver function tests or dilated bile duct were not significant. CONCLUSIONS: For the treatment of SOD incorporating pancreatic and biliary sphincterotomy, patient characteristics and pancreatic sphincter manometry may be more important predictors of outcome than the traditional classification based on liver chemistries and bile duct dilation.
Authors: Timothy D Imler; Stuart Sherman; Lee McHenry; Evan L Fogel; James L Watkins; Glen A Lehman Journal: Dig Dis Sci Date: 2012-06-02 Impact factor: 3.199
Authors: Joseph Romagnuolo; Peter B Cotton; Valerie Durkalski; Qi Pauls; Olga Brawman-Mintzer; Douglas A Drossman; Patrick Mauldin; Kyle Orrell; April W Williams; Evan L Fogel; Paul R Tarnasky; Giuseppe Aliperti; Martin L Freeman; Richard A Kozarek; Priya A Jamidar; C Mel Wilcox; Jose Serrano; Grace H Elta Journal: Gastrointest Endosc Date: 2014-01-25 Impact factor: 9.427
Authors: Peter B Cotton; Valerie Durkalski; Joseph Romagnuolo; Qi Pauls; Evan Fogel; Paul Tarnasky; Giuseppe Aliperti; Martin Freeman; Richard Kozarek; Priya Jamidar; Mel Wilcox; Jose Serrano; Olga Brawman-Mintzer; Grace Elta; Patrick Mauldin; Andre Thornhill; Robert Hawes; April Wood-Williams; Kyle Orrell; Douglas Drossman; Patricia Robuck Journal: JAMA Date: 2014-05 Impact factor: 56.272
Authors: Jessica M Gutierrez; Howard Lederer; Jon C Krook; Timothy P Kinney; Martin L Freeman; Eric H Jensen Journal: J Gastrointest Surg Date: 2009-09-24 Impact factor: 3.452
Authors: Evangelos Kalaitzakis; Tim Ambrose; Jane Phillips-Hughes; Jane Collier; Roger W Chapman Journal: BMC Gastroenterol Date: 2010-10-22 Impact factor: 3.067