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Sphincter of Oddi manometry: is normal always normal?
▶ Khashab MA, Watkins JL, McHenry L Jr, et al. Frequency of sphincter of Oddi dysfunction in patients with previously normal sphincter of Oddi manometry studies. Endoscopy 2010;42:369–74.
Sphincter of Oddi manometry (SOM) is the only test available that directly measures sphincter of Oddi pressure and has been suggested as the ‘gold standard’ in the diagnosis of patients with suspected sphincter of Oddi dysfunction (SOD). An abnormal test is taken as an indication for sphincterotomy; however, the question remains as to whether a single brief assessment of sphincter pressure reliably excludes the diagnosis. In this large retrospective series from Indiana, all patients who underwent SOM over a 13-year period were identified. Patients with an intact papilla who had an initial normal study, but subsequently underwent repeat SOM because of persistent symptoms formed the study group. Five thousand three hundred and fifty-two patients were identified of which 1037 (19.4%) had normal SOM. Of these, 30 underwent repeat SOM for persistent symptoms: 22 had persistent abdominal pain suggestive of SOD and eight had unexplained recurrent pancreatitis. Repeat SOM was abnormal in 18 (60%), 13/17 (76.5%) patients with suspected type II SOD had abnormal SOM on repeat compared to 5/12 (41.7%) with suspected type III SOD. Post-procedural pancreatitis occurred in 5/30 (16.7%) all of whom had post-procedural pancreatic duct stenting. The authors conclude that a single SOM study may not represent the day-to-day physiology of the sphincter of Oddi and that repeat endoscopic retrograde cholangiopancreatography (ERCP) and manometry may be warranted in patients with debilitating symptoms and a high index of suspicion. A caveat in interpreting these results is that the proportion of patients with normal SOM …
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