TITLE

Prospective comparison of secretin-stimulated magnetic resonance cholangiopancreatography with manometry in the diagnosis of sphincter of Oddi dysfunction types II and III

AUTHOR(S)
Pereira, Stephen P.; Gillams, Alice; Sgouros, Spiros N.; Webster, George J. M.; Hatfield, Adrian R. W.
PUB. DATE
June 2007
SOURCE
Gut;Jun2007, Vol. 56 Issue 6, p809
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: In sphincter of Oddi dysfunction (SOD), sphincter of Oddi manometry (SOM) predicts the response to sphincterotomy, but is invasive and associated with complications. Aim: To evaluate the role of secretin-stimulated magnetic resonance cholangiopancreatography (ss-MRCP) in predicting the results of SOM in patients with suspected type II or III SOD. Methods: MRCP was performed at baseline and at 1, 3, 5 and 7 mm after intravenous secretin. SOD was diagnosed when the mean basal sphincter pressure at SOM was >40 mm Hg. Long-term outcome after SOM, with or without endoscopic sphincterotomy, was assessed using an 11-point (0–10) Likert scale. Results: Of 47 patients (male/female 9/38; mean age 46 years; range 27–69 years) referred for SOM, 27 (57%) had SOD and underwent biliary and/or pancreatic sphincterotomy. ss-MRCP was abnormal in 10/16 (63%) type II and 0/11 type III SOD cases. The diagnostic accuracy of ss-MRCP for SOD types II and III was 73% and 46%, respectively. During a mean follow-up of 31.6 (range 17–44) months, patients with normal SOM and SOD type II experienced a significant reduction in symptoms (mean Likert score 8 vs 4; p=0.03, and 9 vs 1.6; p=0.0002, respectively), whereas in patients with SOD type III, there was no improvement in pain scores. All patients with SOD and an abnormal ss-MRCP (n = 12) reported long-term symptom improvement (mean Likert score 9.2 v 1 .2, p<0.001). Conclusions: ss-MRCP is insensitive in predicting abnormal manometry in patients with suspected type III SOD, but is useful in selecting patients with suspected SOD II who are most likely to benefit from endotherapy.
ACCESSION #
25508465

 

Related Articles

  • PROSPECTIVE COMPARISON OF SECRETIN STIMULATED MRCP WITH SPHINCTER OF ODDI MANOMETRY IN THE DIAGNOSIS OF SPHINCTER OF ODDI DYSFUNCTION. Pereira, S.P.; Gillams, A.R.; Hatfield, A.W.R. // Gut;Apr2003 Supplement 1, Vol. 52, pA24 

    Background: Sphincter of Oddi manometry (SOM) is the gold standard for the diagnosis of sphincter of Oddi dysfunction (SOD) and predicts response to sphincterotomy, but it is invasive and associated with complications. Aim: To evaluate the role of secretin stimulated magnetic resonance...

  • THE SIGNIFICANCE OF ELEVATED AMPULLARY SPHINCTER PRESSURE. Steinberg, William M. // American Journal of Gastroenterology;Jul1989, Vol. 84 Issue 7, p712 

    Discusses the significance of an elevated ampullary sphincter pressure obtained during endoscopic retrograde cholangiopancreatography in a patient with recurring abdominal pain of uncertain etiology. Problems with interpretation of data on sphincter of Oddi pressure; Beneft of using endoscopic...

  • Narcotic Analgesic Effects on the Sphincter of Oddi: A Review of the Data and Therapeutic Implications in Treating Pancreatitis. Thompson, Donald R. // American Journal of Gastroenterology;Apr2001, Vol. 96 Issue 4, p1266 

    OBJECTIVE: Traditional teaching dictates that morphine induces "spasm" in the sphincter of Oddi (SO) and should not be used in acute pancreatitis and that meperidine is the analgesic of choice because it does not elevate SO pressures. A literature search and review was performed to evaluate this...

  • Nitrate Therapy in a Patient with Papillary Dysfunction. Bar-Meir, Simon; Halpern, Zamir; Bardan, Eithan // American Journal of Gastroenterology;Feb1983, Vol. 78 Issue 2, p94 

    A 64-yr-old woman with ERCP manometry proven papillary dysfunction is described. This patient responded to nitrate therapy with disappearance of the pain and decrease in both basal and phasic sphincter activity. It is suggested that nitrate administration should be used to distinguish between...

  • Laparoscopy-Assisted Transjejunal ERCP in a Patient with Roux-en-Y Reconstruction Following Partial Gastrectomy. Lopes, Tercio L.; Clements, Ronald H.; Wilcox, C. Mel // Journal of Laparoendoscopic & Advanced Surgical Techniques;Jan/Feb2010, Vol. 20 Issue 1, p55 

    In this article, we report a patient with a history of partial gastrectomy and Roux-en-Y reconstruction who presented with abdominal pain due to sphincter of Oddi dysfunction. After failed endoscopic retrograde cholangiopancreatography (ERCP) through the anatomic route, the procedure was...

  • The secret (GTN) of successful ERCP cannulation: a prospective randomised controlled study. Ghori, A.; Hallisey, M.; Nwokolo, C.; Loft, D.; Fraser, I. // Journal of the Royal College of Surgeons of Edinburgh;Aug2002, Vol. 47 Issue 4, p634 

    Assesses the effect of glyceryl trinitrate (GTN) on the smooth muscle of the sphincter of Oddi, in terms of ease of cannulation at endoscopic retrograde cholangiopancreatography. Side effects of GTN; Effect of GTN among the experienced endoscopists and trainees; Difference in the average time...

  • Botulinum toxin-induced relaxation of the sphincter of Oddi may select patients with acalculous biliary pain who will benefit from cholecystectomy. Murray, William R. // Surgical Endoscopy;Mar2011, Vol. 25 Issue 3, p813 

    Background: Acalculous biliary pain may be due to gallbladder dyskinesia or sphincter of Oddi (SO) hypertension. These two etiologies are difficult to differentiate because the gallbladder ejection fraction may be low and the SO manometry results may be abnormal in both. Cholecystectomy is...

  • Management of patients with biliary sphincter of Oddi disorder without sphincter of Oddi manometry. Kalaitzakis, Evangelos; Ambrose, Tim; Phillips-Hughes, Jane; Collier, Jane; Chapman, Roger W. // BMC Gastroenterology;2010, Vol. 10, p124 

    Background: The paucity of controlled data for the treatment of most biliary sphincter of Oddi disorder (SOD) types and the incomplete response to therapy seen in clinical practice and several trials has generated controversy as to the best course of management of these patients. In this...

  • A Trial of Rectal Indomethacin to Prevent Post-ERCP Pancreatitis in Patients with Suspected Type 3 Sphincter of Oddi Dysfunction. Siddiqui, Ali; Patel, Devi; Kaplan, Jeremy; Zabolotsky, Andrew; Loren, David; Kowalski, Thomas; Ghumman, Saad; Adler, Douglas; Munigal, Satish; Hayat, Umar; Eloubeidi, Mohamad // Digestive Diseases & Sciences;Aug2015, Vol. 60 Issue 8, p2509 

    Background and Aim: Recent data have suggested that rectal indomethacin can also reduce the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The aim of this study was to determine whether prophylactic rectal indomethacin with PD stenting would reduce the...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics