Background: SOM has been reported to be successful in obtaining at least one duct in about 75% of attempts. Meperidine has been reported to have no significant affect on basal SO pressures and is being increasingly used to achieve conscious sedation for SOM. The aims of this study were to determine cannulation success and concordance for both biliary and pancreatic SOM in patients (pts) undergoing SOM where meperidine is used. Methods: In an 18 month period, 163 pts underwent ERCP with attempted SOM of both ducts; 41 pts were excluded (22 had a previous biliary or pancreatic sphincterotomy and 19 had a diagnosis of pancreatitis due to alcohol) which left 122 pts as the subject of this report. 72 pts with post-cholecystectomy pain (62F,10M), 12 pts with pain and gallbladder in situ (10F,2M), and 38 patients with unexplained pancreatitis (26F,12M) were studied. SOM was performed with a standard triple lumen aspirating catheter (Wilson-Cook) and considered abnormal if both perfused leads measured ≥ 40mmHg. Results; Successful SOM was obtained from one or both ducts in 121 of 122 (99%) pts. SOM was successful from both ducts in 100 of 122 (82%) and are tabulated below. SOM BothNl Both Abnl → Biliary → Panc Pain Only 24 26 6 13 Pancreatitis 12 11 4 4 Total N=100 36 (36%) 37 (37%) 10 (10%) 17 (17%) Summary: The overall concordance for biliary and pancreatic SOM was 73%. Of pts with abnormal SOM, 27 (42%) had abnormalities confined to only one duct. Conclusions: 1) Improved sedation using meperidine appears to improve cannulation success. 2) Concordance rates of SOM are similar with and without meperidine. 3) Diagnostic information is increased by studying both ducts since isolated sphincter dysfunction is common in pts with SOD. 4) If SOM in either duct is normal, manometry should be attempted in the other duct.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging