Pancreatic sphincter hypertension (PSH) is usually present in patients with sphincter of Oddi dysfunction (SOD). Residual PSH after endoscopic biliary sphincterotomy (EBS) may explain treatment failure in patients with pain or recurrent pancreatitis due to SOD. Purpose: To determine the incidence of residual PSH after EBS. Methods: A consecutive series of patients (n=264) underwent ERCP with attempted pancreatic sphincter of Oddi manometry (SOM). Patients were excluded for normal (n=95) or failed (n=14) pancreatic SOM, calcific pancreatitis (n=33), or age < 18yr (n=8). Thirteen patients with PSH were excluded because EBS was not done (n=4) or repeat pancreatic SOM was not done after EBS (n=9). The remaining 101 patients with PSH (mean basal pressure ≥ 40mmHg) had pancreatic SOM attempted immediately after EBS, and 25 also had pancreatic SOM performed remotely (mean=7wk, range=2-42wk) to evaluate recurrent or persistent symptoms. Indications for SOM were pancreatobiliary pain (n=71) or idiopathic pancreatitis (n=30). Results: Ninety-nine of 101 (98%) had successful pancreatic SOM performed immediately after EBS. Sixty-nine (70%) had residual PSH immediately after EBS. In the patients having repeat pancreatic SOM remotely after EBS, basal pressures were increased in 11 (44%), decreased but still abnormal in 9 of 25 (36%), and normal in 5 of 25 (20%). Patients with normalization of basal pancreatic sphincter pressure (PSP) after EBS (immediately or remotely) had significantly lower PSP on initial pancreatic SOM (see table, x̄ ± SEM ). Repeat Pancreatic Residual Initial PSP Repeat PSP SOM after EBS PSH (mmHg) * (mmHg) Immediately YES (n=69) 169 ±13 163 ± 12 n=99 NO (n=30) 76 ± 5 < 40 Remotely YES (n=20) 157 ± 24 166 ± 25 n=25 NO(n=5) 68 ± 10 <40 * p<0.001, comparing initial PSP: patients with vs. without residual PSH Conclusions: Pancreatic SOM immediately normalizes in less than onethird of SOD patients immediately after EBS. Residual PSH is more likely after EBS in patients with higher pancreatic SOM initially.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging