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Endoscopy
Original research
Sphincterotomy for biliary sphincter of Oddi disorder and idiopathic acute recurrent pancreatitis: the RESPOnD longitudinal cohort
  1. Gregory A Coté1,
  2. Badih Joseph Elmunzer2,
  3. Haley Nitchie3,
  4. Richard S Kwon4,
  5. Field Willingham5,
  6. Sachin Wani6,
  7. Vladimir Kushnir7,
  8. Amitabh Chak8,
  9. Vikesh Singh9,
  10. Georgios I Papachristou10,
  11. Adam Slivka11,
  12. Martin Freeman12,
  13. Srinivas Gaddam13,
  14. Priya Jamidar14,
  15. Paul Tarnasky15,
  16. Shyam Varadarajulu16,
  17. Lydia D Foster17,
  18. Peter Cotton18
  1. 1Department of Medicine, Division of Gastroenterology & Hepatology, Oregon Health & Science University, Portland, Oregon, USA
  2. 2Gastroenterology, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3Department of Medicine, Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4Medicine/Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
  5. 5Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
  6. 6School of Medicine, University of Colorado—Anschutz Medical Campus, Aurora, Colorado, USA
  7. 7Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
  8. 8Division of Gastroenterology and Liver Disease, University Hospitals Case Medical Center, Cleveland, Ohio, USA
  9. 9Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
  10. 10Department of Medicine, Division of Gastroenterology & Hepatology, The Ohio State University, Columbus, Ohio, USA
  11. 11Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  12. 12University of Minnessota, Minneapolis, Minnesota, USA
  13. 13Cedars-Sinai Medical Center, Los Angeles, California, USA
  14. 14Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  15. 15Methodist Digestive Institute, Dallas, Texas, USA
  16. 16Digestive Health Institute, Orlando, Florida, USA
  17. 17Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA
  18. 18Medicine, DDC, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Gregory A Coté, Department of Medicine, Division of Gastroenterology & Hepatology, Oregon Health & Science University, Portland, OR 97239, USA; coteg{at}ohsu.edu

Abstract

Objective Sphincter of Oddi disorders (SOD) are contentious conditions in patients whose abdominal pain, idiopathic acute pancreatitis (iAP) might arise from pressurisation at the sphincter of Oddi. The present study aimed to measure the benefit of sphincterotomy for suspected SOD.

Design Prospective cohort conducted at 14 US centres with 12 months follow-up. Patients undergoing first-time endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy for suspected SOD were eligible: pancreatobiliary-type pain with or without iAP. The primary outcome was defined as the composite of improvement by Patient Global Impression of Change (PGIC), no new or increased opioids and no repeat intervention. Missing data were addressed by hierarchal, multiple imputation scheme.

Results Of 316 screened, 213 were enrolled with 190 (89.2%) of these having a dilated bile duct, abnormal labs, iAP or some combination. By imputation, an average of 122/213 (57.4% (95% CI 50.4% to 64.4%)) improved; response rate was similar for those with complete follow-up (99/161, 61.5% (54.0% to 69.0%)); of these, 118 (73.3%) improved by PGIC alone. Duct size, elevated labs and patient characteristics were not associated with response. AP occurred in 37/213 (17.4%) at a median of 6 months post ERCP and was more likely in those with a history of AP (30.9% vs 2.9%, p<0.0001).

Conclusion Nearly 60% of patients undergoing ERCP for suspected SOD improve, although the contribution of a placebo response is unknown. Contrary to prevailing belief, duct size and labs are poor response predictors. AP recurrence was common and like observations from prior non-intervention cohorts, suggesting no benefit of sphincterotomy in mitigating future AP episodes.

  • ABDOMINAL PAIN
  • FUNCTIONAL BOWEL DISORDER
  • ACUTE PANCREATITIS
  • ENDOSCOPIC RETROGRADE PANCREATOGRAPHY
  • ENDOSCOPIC SPHINCTEROTOMY

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/gutjnl-2024-332686

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors GAC is the guarantor of this article. Each author contributed substantially to this paper through: (1) substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; (2) drafting the work or revising it critically for important intellectual content; (3) final approval of the version to be published; and (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under award number R01DK115495 (Cote, Foster, Cotton).

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.