Complications of sphincter of Oddi manometry: biliary-like pain versus acute pancreatitis

Endoclip papillaplasty restores sphincter of Oddi function: Pilot study

OBJECTIVES

Endoscopic sphincterotomy (EST) damaged the sphincter of Oddi (SO) function. This study aimed to explore the feasibility and efficacy of endoclip papillaplasty in restoring SO function.

METHODS

This prospective pilot study included consecutive patients with choledocholithiasis (stone size ≥10 mm) who underwent large-EST for stone removal, followed by endoclip papillaplasty, between May 2018 and March 2019.

RESULTS

Thirty patients were enrolled in this trail. Overall, 80% of the patients had a SO basal pressure of >10 mmHg after endoclip papillaplasty. Manometric parameters, including SO basal pressure, phasic wave contraction amplitude, phasic waves per minute, recovered after endoclip papillaplasty (P > 0.05). There were no significant differences in the manometric parameters of SO between healing grades A and B. Six patients developed mild post-endoscopic retrograde cholangiopancreatography pancreatitis, including three that had pancreatic stenting. Bile duct stone recurrence developed in 3.3% of the patients (1/30) during an 18-month follow-up.

CONCLUSIONS

Endoclip papillaplasty might restore SO function and possibly prevented biliary stone and cholangitis recurrence.

Complications of endoscopic retrograde cholangiopancreatography (ERCP) and their risk factors

PURPOSE

Determination of the type and frequency of complications developing after diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) as well as the risk factors predisposing to them.

MATERIAL/METHODS

The retrospective study, including 734 ERCP performed in 550 patients, with 404 (55%) ES (endoscopic sphincterotomy) during a 4-year period.

RESULTS

Among 734 ERCP procedures, 76.4% (561) had both diagnostic and therapeutic purpose, 15.2% (112) were only diagnostic. Complications developed after 26 procedures (3.5%): acute pancreatitis (AP) in 8 patients (1.09%), cholangitis in 7 (0.95%) and delayed bleeding in 11 (1.5%) patients. After 49 (6.7%) ES immediate bleeding was observed. The risk factors for AP were: unintentional pancreatic duct contrasting, mechanical lithotripsy, the use of the "pre-cut" technique and bile duct dilatation. Cholangitis was more common in cases with difficult cannulation at older age and with lower baseline bilirubin level. The risk factors for delayed bleeding were: location of the ampulla of Vater in the diverticulum and the use of the "precut" technique. Immediate bleeding was more frequent after revision of bile ducts with Dormia's basket or with balloon, after introduction of contrast medium to the pancreatic duct or in ductal cholelithiasis.

CONCLUSIONS

ERCP performed in the endoscopy unit of a specialist hospital department is a relatively safe procedure, with a low burden of complications as compared to the benefits it provides to appropriately qualified patients.

The feasibility and reliability of using circular electrode for sphincter of Oddi electromyography in anaesthetised rabbits

Sphincter of Oddi manometry (SOM) is the gold standard for assessing sphincter of Oddi dysfunction (SOD), but is considered a diagnostic sensitivity of 30-80% and associated with significant complications of pancreatitis. Electromyography (EMG) of sphincter of Oddi (SO) using a circular electrode (CE) may be useful in improving diagnostic accuracy and reducing complications. To evaluate the feasibility and reliability of the CE, we record myoelectric activity of SO in rabbits using the CE to compare with the traditional needle electrode (NE). The CE was prepared using a double-channel biogel catheter with two silver rings at the head of the catheter. The CE was then inserted into the lumen of the SO through the duodenal papilla, and myoelectric activity was recorded in the SO in 30 rabbits. An EMG recorded using an NE was performed at the same time, when the SO was in basal state, after injection of cholecystokinin and N-butylscopolamine bromide. Electromyographs recorded by the two methods were then evaluated. Satisfactory SO EMGs were acquired using the CE without any injury. Simultaneous recording revealed a very similar traces and one-to-one correspondence of SO spike bursts (SOSB). Linear regression analysis showed a significant direct correlation between the two methods for SOSB duration and amplitude. The results suggested that CE was comparable with NE in terms of recording efficacy. The CE also has advantages of easy fixation, accurate localisation, broad applicability and ease of achieving satisfactory outcomes without trauma, compared with the NE.

Comparison of secretin-stimulated magnetic resonance pancreatography and manometry results in patients with suspected sphincter of oddi dysfunction

RATIONALE AND OBJECTIVES

To measure main pancreatic duct diameter (PDD) with magnetic resonance pancreatography (MRP) before and after secretin injection in patients with suspected sphincter of Oddi dysfunction (SOD) and to determine if the diameter change is predictive of sphincter of Oddi manometry (SOM) results.

MATERIALS AND METHODS

We identified all patients during the study period referred for SOM for clinically suspected SOD; patients with an intact sphincter and without contraindication to MRP examination were considered for study entry. Consenting patients underwent MRP, including dynamic imaging of the pancreatic duct after intravenous administration of porcine secretin followed by SOM during endoscopic retrograde cholangiopancreatography. MRP was defined as abnormal when PDD remained increased by > or = 1.0 mm from baseline 15 minutes after secretin injection. SOM was abnormal when basal sphincter pressure (SP) was > or = 40 mm Hg. Mean PDD before and after secretin administration was compared within normal and abnormal SP groups with two-tailed unpaired t-test; the mean difference between baseline and peak PDD and duration of > or = 0.5 mm increase in PDD was compared between groups with two-tailed t-test. P < .05 was considered significant.

RESULTS

Of 70 patients referred for SOM, 30 met all entry criteria, gave consent to participate, and underwent both MRP and SOM. Ten of 30 patients (33%) had normal SP; 20 (67%) were abnormal. PDD increased significantly after secretin injection (normal SP, 1.62 +/- 0.73 to 2.78 +/- 0.77 mm, P < .01; abnormal SP, 1.45 +/- 0.26 to 2.32 +/- 0.75 mm, P < .01). There was no difference between normal and abnormal SP groups in amount of PDD increase (1.15 +/- 0.75 vs. 0.88 +/- 0.72 mm; P = .33) or duration of > or = 0.5 mm increase in PDD (5.28 +/- 8.76 vs. 13.60 +/- 13.00 minutes; P = 0.07).

CONCLUSIONS

In patients with suspected sphincter of Oddi dysfunction, magnetic resonance pancreatography demonstrated PDD increase following secretin injection but did not predict the results of manometry.

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