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Sphincter of Oddi Manometry: Reproducibility of Measurements and Effect of Sphincterotomy in the EPISOD Study.

Suarez AL, Pauls Q, Durkalski-Mauldin V, Cotton PB - J Neurogastroenterol Motil (2016)

Bottom Line: Biliary and pancreatic measurements were reproduced in 7/14 (50%) untreated subjects.Paradoxically, normal biliary pressures became abnormal in 1 of 15 subjects after biliary sphincterotomy, and normal pancreatic pressures became abnormal in 5 of 15 patients after biliary sphincterotomy, and in 1 of 9 after pancreatic sphincterotomy.Our data suggest that SOM measurements are poorly reproducible, and question whether we could adequately perform pancreatic sphincterotomy.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, SC, USA.

ABSTRACT

Background/aims: The reproducibility of sphincter of Oddi manometry (SOM) measurements and results of SOM after sphincterotomy has not been studied sufficiently. The aim of our study is to evaluate the reproducibility of SOM and completeness of sphincter ablation.

Methods: The recently published Evaluating Predictors and Interventions in sphincter of Oddi dysfunction (EPISOD) study included 214 subjects with post-cholecystectomy pain, and fit the criteria of sphincter of Oddi dysfunction type III. They were randomized into 3 arms, irrespective of manometric findings: sham (no sphincterotomy), biliary sphincterotomy, and dual (biliary and pancreatic). Thirty-eight subjects had both biliary and pancreatic manometries performed twice, at baseline and at repeat endoscopic retrograde cholangiopancreatography after 1-11 months. Sham arm was examined to assess the reproducibility of manometry, and the treatment arms to assess whether the sphincterotomies were complete (elevated pressures were normalized).

Results: Biliary and pancreatic measurements were reproduced in 7/14 (50%) untreated subjects. All 12 patients with initially elevated biliary pressures in biliary and dual sphincterotomy groups normalized after biliary sphincterotomy. However, 2 of 8 subjects with elevated pancreatic pressures in the dual sphincterotomy group remained abnormal after pancreatic sphincterotomy. Paradoxically, normal biliary pressures became abnormal in 1 of 15 subjects after biliary sphincterotomy, and normal pancreatic pressures became abnormal in 5 of 15 patients after biliary sphincterotomy, and in 1 of 9 after pancreatic sphincterotomy.

Conclusions: Our data suggest that SOM measurements are poorly reproducible, and question whether we could adequately perform pancreatic sphincterotomy.

No MeSH data available.


Related in: MedlinePlus

After biliary sphincterotomy: biliary (A) and pancreatic (B) pressures. Figures represent biliary or pancreatic basal pressure readings during initial and repeat sphincter of Oddi manometry (SOM). A basal pressure > 40 mmHg is defined as abnormal. For clarity, any values over 200 mmHg have been graphed at > 200 mmHg, and all reports of “normal manometry” without actual numbers are recorded as normal.
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f2-jnm-22-477: After biliary sphincterotomy: biliary (A) and pancreatic (B) pressures. Figures represent biliary or pancreatic basal pressure readings during initial and repeat sphincter of Oddi manometry (SOM). A basal pressure > 40 mmHg is defined as abnormal. For clarity, any values over 200 mmHg have been graphed at > 200 mmHg, and all reports of “normal manometry” without actual numbers are recorded as normal.

Mentions: The 15 subjects treated by biliary sphincterotomy had a mean age of 34.1 (SD: 7.1) years, and 14 (93%) were female. Of the biliary pressures, 8 remained normal, 6 normalized, and 1 became abnormal. Of the pancreatic pressures, 4 remained normal, 6 remained abnormal, and 5 became abnormal (Fig. 2).


Sphincter of Oddi Manometry: Reproducibility of Measurements and Effect of Sphincterotomy in the EPISOD Study.

Suarez AL, Pauls Q, Durkalski-Mauldin V, Cotton PB - J Neurogastroenterol Motil (2016)

After biliary sphincterotomy: biliary (A) and pancreatic (B) pressures. Figures represent biliary or pancreatic basal pressure readings during initial and repeat sphincter of Oddi manometry (SOM). A basal pressure > 40 mmHg is defined as abnormal. For clarity, any values over 200 mmHg have been graphed at > 200 mmHg, and all reports of “normal manometry” without actual numbers are recorded as normal.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4930303&req=5

f2-jnm-22-477: After biliary sphincterotomy: biliary (A) and pancreatic (B) pressures. Figures represent biliary or pancreatic basal pressure readings during initial and repeat sphincter of Oddi manometry (SOM). A basal pressure > 40 mmHg is defined as abnormal. For clarity, any values over 200 mmHg have been graphed at > 200 mmHg, and all reports of “normal manometry” without actual numbers are recorded as normal.
Mentions: The 15 subjects treated by biliary sphincterotomy had a mean age of 34.1 (SD: 7.1) years, and 14 (93%) were female. Of the biliary pressures, 8 remained normal, 6 normalized, and 1 became abnormal. Of the pancreatic pressures, 4 remained normal, 6 remained abnormal, and 5 became abnormal (Fig. 2).

Bottom Line: Biliary and pancreatic measurements were reproduced in 7/14 (50%) untreated subjects.Paradoxically, normal biliary pressures became abnormal in 1 of 15 subjects after biliary sphincterotomy, and normal pancreatic pressures became abnormal in 5 of 15 patients after biliary sphincterotomy, and in 1 of 9 after pancreatic sphincterotomy.Our data suggest that SOM measurements are poorly reproducible, and question whether we could adequately perform pancreatic sphincterotomy.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, SC, USA.

ABSTRACT

Background/aims: The reproducibility of sphincter of Oddi manometry (SOM) measurements and results of SOM after sphincterotomy has not been studied sufficiently. The aim of our study is to evaluate the reproducibility of SOM and completeness of sphincter ablation.

Methods: The recently published Evaluating Predictors and Interventions in sphincter of Oddi dysfunction (EPISOD) study included 214 subjects with post-cholecystectomy pain, and fit the criteria of sphincter of Oddi dysfunction type III. They were randomized into 3 arms, irrespective of manometric findings: sham (no sphincterotomy), biliary sphincterotomy, and dual (biliary and pancreatic). Thirty-eight subjects had both biliary and pancreatic manometries performed twice, at baseline and at repeat endoscopic retrograde cholangiopancreatography after 1-11 months. Sham arm was examined to assess the reproducibility of manometry, and the treatment arms to assess whether the sphincterotomies were complete (elevated pressures were normalized).

Results: Biliary and pancreatic measurements were reproduced in 7/14 (50%) untreated subjects. All 12 patients with initially elevated biliary pressures in biliary and dual sphincterotomy groups normalized after biliary sphincterotomy. However, 2 of 8 subjects with elevated pancreatic pressures in the dual sphincterotomy group remained abnormal after pancreatic sphincterotomy. Paradoxically, normal biliary pressures became abnormal in 1 of 15 subjects after biliary sphincterotomy, and normal pancreatic pressures became abnormal in 5 of 15 patients after biliary sphincterotomy, and in 1 of 9 after pancreatic sphincterotomy.

Conclusions: Our data suggest that SOM measurements are poorly reproducible, and question whether we could adequately perform pancreatic sphincterotomy.

No MeSH data available.


Related in: MedlinePlus