TITLE

PROSPECTIVE COMPARISON OF SECRETIN STIMULATED MRCP WITH SPHINCTER OF ODDI MANOMETRY IN THE DIAGNOSIS OF SPHINCTER OF ODDI DYSFUNCTION

AUTHOR(S)
Pereira, S.P.; Gillams, A.R.; Hatfield, A.W.R.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA24
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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 cholangiopancreatiography (ssMRCP) in predicting the results of ERCP+SOM n patients with clinically suspected type II (pancreaticobiliary type pain + duct dilatation or abnormal liver biochemistry/ recurrent pancreatitis) or type III (pain alone) SOD. Methods: 43 patients 35F 8M; mean age 46 years, range 27-69 years) referred for SOM from 28 hospitals were studied. MRCP was performed at baseline and at 1, 3, 5, and 7 min after IV secretin (0.1 mi/kg). Five 10-15 mm coronal images were obtained in a single breath hold using a heavily T2 weighted, fat suppressed fast spin-echo sequence on a Siemens 1.5T MR system. All MRCP studies were reported by one radiologist who was blinded to the SOM findings. SOM was performed using a standard 5F wire-guided triple lumen water perfused manometry catheter, and SOD diagnosed when the mean basal sphincter pressure was > 40 mm Hg (sustained for > 30 sec and observed in both leads). Results: 23 patients (53%) had manometrically-proven SOD: 16 type II (8 biliary, 7 pancreatic, 1 both) and 7 type III. ssMRCP was abnormal in 10 of the 16 patients (63%) with type II SOD, but in none of the 7 with type III SOD. 14 patients had normal ERCP+SOM studies, in whom ssMRCP was also normal, and a further 6 patients with normal SOM were found to have morphological changes of moderately severe chronic pancreatitis on both ERCP and ssMRCP. Conclusions: ssMRCP is insensitive in predicting abnormal manometry in patients with suspected type III SOD, but correlates well with ERCP+SOM in detecting structural disease of the sphincter or pancreas.
ACCESSION #
9747421

 

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