The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Risk Stratification for the Development of Post-ERCP Pancreatitis by Sphincter of Oddi Dysfunction Classification

Authors: Sara Beltz, MD, Avik Sarkar, MD, David E. Loren, MD, Jocelyn Andrel, MS, Thomas Kowalski, MD, Ali A. Siddiqui, MD

Abstract

Objectives: To explore whether there is a difference in the frequency of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in patients with manometrically confirmed sphincter of Oddi dysfunction (SOD) types I, II, and III.


Methods: A retrospective review of all of the patients who underwent an ERCP with SOD type I or patients with manometrically confirmed SOD type II or type III (mean basal sphincter pressure ≥40 mm Hg) from 2006 to 2010 was performed. The primary outcome measure was development of post-ERCP acute pancreatitis in each of the SOD groups. Factors associated with acute pancreatitis in each group were examined by univariate analysis.


Results: We identified 147 patients with SOD. Biliary sphincterotomy was performed in all of the patients, and pancreatic sphincterotomy was performed in 68 of the 147 (46%). All of the patients underwent stenting of the pancreatic duct. Post-ERCP pancreatitis occurred in 23% of the study cohort. Patients with SOD type III had a higher frequency of post-ERCP pancreatitis compared with the SOD type I and type II groups (31% vs 20% vs 6%, respectively; P = 0.024). Those with SOD type III had a greater frequency of post-ERCP pancreatitis (odds ratio 6.7; P = 0.05) compared with those with SOD type I. Patients with SOD type III had a two times greater frequency of developing post-ECRP pancreatitis compared with those with SOD type II.


Conclusions: SOD type III is strongly associated with the development of post-ERCP pancreatitis compared with SOD type I.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Hogan W. The post-cholecystectomy syndrome: the role of sphincter-of-Oddi dysfunction.Bildgebung 1992; 59 (1 suppl): 42–50.
 
2. Geenen JE, Hogan WJ, Dodds WJ, et al. The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med 1989; 320: 82–87.
 
3. Petersen BT. An evidence-based review of sphincter of Oddi dysfunction: part I, presentations with “objective” biliary findings (types I and II). Gastrointest Endosc 2004; 59: 525–534.
 
4. Behar J, Corazziari E, Guelrud M, et al. Functional gallbladder and sphincter of Oddi disorders. Gastroenterology 2006; 130: 1498–1509.
 
5. Chen YK, Foliente RL, Santoro MJ, et al. Endoscopic sphincterotomy-induced pancreatitis: increased risk associated with nondilated bile ducts and sphincter of Oddi dysfunction. Am J Gastroenterol 1994; 89: 327–333.
 
6. Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001; 54: 425–434.
 
7. Tarnasky P, Cunningham J, Cotton P, et al. Pancreatic sphincter hypertension increases the risk of post-ERCP pancreatitis. Endoscopy 1997; 29: 252–257.
 
8. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383–393.
 
9. Sherman S, Lehman GA. ERCP- and endoscopic sphincterotomy-induced pancreatitis. Pancreas 1991; 6: 350–367.
 
10. Silverman WB, Ruffolo TA, Sherman S, et al. Correlation of basal sphincter pressures measured from the bile duct and the pancreatic duct in patients with suspected sphincter of Oddi dysfunction.Gastrointest Endosc 1992; 38: 440–443.
 
11. Johnson GK, Geenen JE, Bedford RA, et al. A comparison of nonionic versus ionic contrast media: results of a prospective, multicenter study. Midwest Pancreaticobiliary Study Group. Gastrointest Endosc 1995; 42: 312–316.
 
12. Smithline A, Silverman W, Rogers D, et al. Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patients.Gastrointest Endosc 1993; 39: 652–657.
 
13. Sherman S, Ruffolo TA, Hawes RH, et al. Complications of endoscopic sphincterotomy. A prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts. Gastroenterology 1991; 101: 1068–1075.
 
14. Fogel EL, Eversman D, Jamidar P, et al. Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone. Endoscopy 2002; 34: 280–285.
 
15. Sherman S, Troiano FP, Hawes RH, et al. Frequency of abnormal sphincter of Oddi manometry compared with the clinical suspicion of sphincter of Oddi dysfunction. Am J Gastroenterol 1991; 86: 586–590.
 
16. Desautels SG, Slivka A, Hutson WR, et al. Postcholecystectomy pain syndrome: pathophysiology of abdominal pain in sphincter of Oddi type III. Gastroenterology 1999; 116: 900–905.
 
17. Tarnasky PR, Palesch YY, Cunningham JT, et al. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology 1998; 115: 1518–1524.
 
18. Saad AM, Fogel EL, McHenry L, et al. Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results. Gastrointest Endosc 2008; 67: 255–261.
 
19. Pfau PR, Banerjee S, Barth, et al. Sphincter of Oddi manometry. Gastrointest Endosc 2011; 74: 1175–1180.
 
20. Bozkurt T, Orth KH, Butsch B, et al. Long-term clinical outcome of post-cholecystectomy patients with biliary-type pain: results of manometry, non-invasive techniques and endoscopic sphincterotomy.Eur J Gastroenterol Hepatol 1996; 8: 245–249.
 
21. Botoman VA, Kozarek RA, Novell LA, et al. Long-term outcome after endoscopic sphincterotomy in patients with biliary colic and suspected sphincter of Oddi dysfunction. Gastrointest Endosc 1994; 40: 165–170.
 
22. Sherman S, Troiano FP, Hawes RH, et al. Sphincter of Oddi manometry: decreased risk of clinical pancreatitis with use of a modified aspirating catheter. Gastrointest Endosc 1990; 36: 462–466.
 
23. Sherman S, Hawes RH, Rathgaber SW, et al. Post-ERCP pancreatitis: randomized, prospective study comparing a low- and high-osmolality contrast agent. Gastrointest Endosc 1994; 40: 422–427.
 
24. Thune A, Jivegård L, Conradi N, et al. Cholecystectomy in the cat damages pericholedochal nerves and impairs reflex regulation of the sphincter of Oddi. A mechanism for postcholecystectomy biliary dyskinesia. Acta Chir Scand 1988; 154: 191–194.
 
25. Soffer EE, Johlin FC. Intestinal dysmotility in patients with sphincter of Oddi dysfunction. A reason for failed response to sphincterotomy. Dig Dis Sci 1994; 39: 1942–1946.
 
26. Baillie J. Management of post-ERCP pancreatitis. Gastroenterol Hepatol 2011; 7: 390–392.