Introduction Persistent biliary pain following cholecystectomy can be a challenging symptom to manage and the role of sphinterotomy has been questioned. Manometry during ERCP has been available in our unit since 2013 for patients with suspected type II sphincter of Oddi dysfunction (SOD). The aim of this study was to assess the response to sphincterotomy following manometric confirmation of a hypertensive sphincter and to assess the safety of this procedure.
Method Patients fulfilling criteria for type II SOD underwent ERCP and manometry with the Cook long nose catheter. Pressure was zeroed in the duodenum prior to insertion into the common bile duct and a minimum of 2 pull-throughs performed. A persistent trough pressure ≥40 mmHg was considered hypertensive and an indication to perform sphincterotomy. All patients had rectal Diclofenac and an attempt at insertion of a prophylactic stent. Primary outcomes were reduction in abdominal pain and post-procedural complication rate. Coexistent anxiety, depression and functional disorders were also noted.
Results 20 patients (mean age 42yrs and 18 females) were included (shown in Table 1). 4/20 did not receive a stent due to concomitant pancreas divisum (PD) and there were no complications during the procedure. 4/20 had acute pancreatitis post ERCP (3 mild, 1 moderate). Patients were followed-up at a mean of 10.9 weeks with the majority of patients finding benefit post sphincterotomy. 3/9 responders v 2/4 non-responders had a history of anxiety/depression and 6/10 responders v 2/4 non-responders had other functional disorders. 6 patients are awaiting follow-up.
Conclusion Manometry is helpful in predicting response to sphincterotomy in patients with type II SOD with 71% having significantly improved or abolished pain at early follow up. Pancreatitis occurred in 20%, consistent with previous reports in the literature of up to 24%.1There was a higher proportion of anxiety/depression in non-responders but no difference in the proportion with functional disorders between groups. However, study numbers are too small to assess these parameters accurately.
Disclosure of interest None Declared.
Toouli et al. Functional Gallbladder and Sphincter of Oddi Disorders. Gastroenterology 2006;130:1498–1509