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

doi:10.1186/1471-230X-10-124

BMC Gastroenterology

Table 3 Risk factors for post-ERCP pancreatitis and outcome of patients undergoing endoscopic sphincterotomy (n = 23).

From: Management of patients with biliary sphincter of Oddi disorder without sphincter of Oddi manometry

Patient	Gender	Age at presentation	SOD type	Follow-up (months)	No of ERCPs	Pancreatic duct injection at 1st ERCP	Pre-cut sphincterotomy at 1st ERCP	Outcome of 1st ERCP	Recurrence after 1st ERCP	Complication
1	Female	49	I	50	4^a	Yes	No	No effect		No
2	Female	66	II	89	1	Yes	Yes	No effect		pancreatitis
3	Male	34	III	0	1	Yes	No	No effect		pancreatitis
4	Female	29	II	37	2^b	No	No	Improvement	Yes	No
5	Female	36	I	16	2	Yes	Yes	Resolution	No	pancreatitis (1st ERCP)
6	Female	27	I	10	1	No	No	Improvement	No	No
7	Female	44	II	27	1	Yes	Yes	No effect		retroperitoneal perforation
8	Female	47	II	39	2^c	Yes	No	No effect		pancreatitis (2nd ERCP)
9	Female	49	II	24	1	No	Yes	Resolution	No	No
10	Female	44	II	22	1	No	No	Improvement	No	No
11	Female	46	II	56	2^d	No	No	No effect		No
12	Female	49	II	43	2^e	No	No	No effect		No
13	Female	47	II	60	4^f	No	No	No effect		No
14	Female	26	I	13	1	No	No	Resolution	No	No
15	Female	46	II	15	1	No	No	No effect		No
16	Female	52	II	34	2^g	Yes	No	Improvement	Yes	No
17	Female	57	II	28	1	No	No	Improvement	Yes	pancreatitis
18	Female	67	II	35	1	No	No	Resolution	Yes	No
19	Female	55	II	49	4^h	Yes	No	Resolution	Yes	No
20	Female	46	II	92	3ⁱ	No	No	Resolution	Yes	pancreatitis (1st ERCP)
21	Female	27	II	110	7^j	No	No	Improvement	Yes	No
22	Female	29	I	35	3^k	Yes	No	Improvement	Yes	pancreatitis (3rd ERCP)
23	Female	43	I	2	2	No	Yes	Improvement	Yes	pancreatitis (1st ERCP)

Conventional over-the-wire biliary sphincterotomy was performed in all patients. In some patients, pre-cut sphincterotomy was performed to obtain access to the common bile duct prior to conventional sphincterotomy. The pre-cut and conventional sphincterotomy were performed during the same procedure apart from patient no 5 and 23 in whom they were performed a few weeks apart from each other as access to the common bile duct was achieved on a subsequent procedure a few weeks after pre-cut sphincterotomy.
^a2nd ERCP, sphincterotomy extended; 3rd ERCP, trial of stent; 4th ERCP, stent removal as it was ineffective
^b2nd ERCP for pancreatic sphincter of Oddi manometry showing raised pressure, pancreatic sphincterotomy performed leading to symptom improvement
^c2nd ERCP, sphincterotomy assessed to be inadequate and was widened with no effect on symptoms
^d2nd ERCP showed patent sphincterotomy, no endotherapy performed
^e2nd ERCP for pancreatic SOM but pancreatic duct cannulation failed
^f2nd ERCP done as pancreatic duct appeared dilated on follow-up MRCP. Pancreatic orifice appeared stenosed. No endotherapy performed as pancreatic stent could not be inserted despite deep guide wire pancreatic duct cannulation; 3rd ERCP for repeat attempt to perform pancreatic sphincterotomy, instrument failure during procedure; 4th ERCP pancreatic stenting and pancreatic sphincterotomy achieved leading to improvement in symptoms
^g2n ERCP for pancreatic SOM normal pancreatic pressure thus no endotherapy performed
^h2nd ERCP showed re-stenosed biliary sphincterotomy, biliary stenting performed; 3rd ERCP cholangitis due to stent obstruction, re-stenting; 4th ERCP extended sphincterotomy
ⁱ2nd ERCP showed patent sphincterotomy, biliary stenting performed; 3rd ERCP removal of stent as ineffective
^j2nd ERCP, patent sphincterotomy, biliary stenting which was effective; 3rd-7th ERCP stent changes until surgery (choledochojejunostomy)
^k2nd ERCP done for pancreatic sphincter of Oddi manometry, raised pancreatic pressure found and pancreatic sphincterotomy performed with improvement in symptoms; 3rd ERCP done due to symptom recurrence showed patent sphincterotomies, referred for surgery (open transduodenal sphincteroplasty)

Back to article page

ISSN: 1471-230X

Contact us

Submission enquiries: bmcgastroenterology@biomedcentral.com
General enquiries: ORSupport@springernature.com