scholarly journals Hypertensive Pancreatic Sphincter

1998 ◽  
Vol 12 (5) ◽  
pp. 333-337 ◽  
Author(s):  
Glen A Lehman ◽  
Stuart Sherman
Keyword(s):  
Sphincter Of Oddi ◽  
Treatment Session ◽  
Noninvasive Testing ◽  
Sphincter Of Oddi Dysfunction ◽  
Sphincter Pressure ◽  
Endoscopic Retrograde ◽  
Biliary Sphincterotomy ◽  
Oddi Dysfunction ◽  
Low Sensitivity ◽  
Pancreatic Sphincterotomy

Major papilla pancreatic sphincter dysfunction, a variant of sphincter of Oddi dysfunction, causes pancreatitis or pancreatic-type pain. Endoscopic manometry as performed at endoscopic retrograde cholangiography is the most commonly used method to identify sphincter dysfunction. Noninvasive testing, such as secretin-stimulated ultrasound analysis of duct diameter, is less reliable and of relatively low sensitivity. Two-thirds of patients with sphincter of Oddi dysfunction have elevated pancreatic basal sphincter pressure. Patients with suspected or documented sphincter of Oddi dysfunction may respond to biliary sphincterotomy alone, but warrant evaluation of their pancreatic sphincter if symptoms persist after therapy. Whether such pancreatic and biliary sphincters should be treated at the first treatment session is controversial. Pancreatic sphincterotomy is associated with a complication rate very similar to that of biliary sphincterotomy except that the pancreatitis rate is two- to fourfold higher. Prophylactic pancreatic stenting diminishes such pancreatitis by approximately 50%.

scholarly journals Sphincter of Oddi Dysfunction: A Perplexing Presentation

2016 ◽  
Vol 10 (3) ◽  
pp. 714-719 ◽  
Author(s):  
Sana Ahmad Din ◽  
Iman Naimi ◽  
Mirza Beg
Keyword(s):  
Abdominal Pain ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Sphincter Of Oddi ◽  
Abdominal Ultrasound ◽  
Sphincter Of Oddi Dysfunction ◽  
Sphincter Pressure ◽  
Abdominal Symptoms ◽  
Biliary Sphincterotomy ◽  
Bile Drainage ◽  
Oddi Dysfunction

Sphincter of Oddi dysfunction is caused by stenosis or dyskinesia of the sphincter of Oddi, leading to blockage of bile drainage from the common bile duct. We present the case of a 16-year-old female with chronic abdominal pain who underwent laparoscopic cholecystectomy for cholelithiasis but continued to experience abdominal pain, nausea, and vomiting along with persistently elevated ALT and AST levels. Postoperative abdominal ultrasound was nondiagnostic. Esophagogastroduodenoscopy showed mild reflux esophagitis and mild chronic Helicobacter pylori-negative gastritis. Omeprazole was started, but it did not decrease the frequency and severity of the abdominal symptoms. Magnetic resonance cholangiopancreatography did not reveal any pathology. Endoscopic retrograde cholangiopancreatography with manometry confirmed an elevated biliary sphincter pressure. Biliary sphincterotomy was performed, and the symptoms improved.

Risk factors of pancreatitis after endoscopic sphincterotomy. Review of literature and practical remarks based on approximately 10,000 ERCPs

2017 ◽  
Vol 89 (5) ◽  
pp. 29-33 ◽  
Author(s):  
Andrzej Jamry
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Endoscopy ◽  
Cumulative Risk ◽  
Sphincter Of Oddi ◽  
Female Gender ◽  
Current Evidence ◽  
Sphincter Of Oddi Dysfunction ◽  
Endoscopic Retrograde ◽  
Oddi Dysfunction ◽  
Associated Risk Factors

Post-endoscopic pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Depending on the presence of risk factors, PEP can occur in 4,1% to about 43% of patients. According to the European Society of Gastrointestinal Endoscopy (ESGE) guidelines, only three to patient-associated risk factors have been identified: suspected sphincter of Oddi dysfunction (SOD) (OR 4.09), female gender (OR 2.23), and previous pancreatitis (OR 2.46). Another three procedure-associated factors include cannulation attempt duration > 10 minutes (OR 1.76), more than one pancreatic guidewire passage (OR 2.77, CI: 1.79 – 4.30), and pancreatic injection (OR 2.2, CI: 1.60 – 3.01). Importantly, analyses of cumulative risk due to coexistence of several factors emphasize the importance of female sex, difficult cannulation, CBD diameter <5 mm, young age, and many other factors. Unfortunately, studies performed to date have included only small numbers of patients with several co-existing risk factors. Therefore, further analysis of other risk factors and the cumulative risk related to their co-occurrence is necessary. Based on current evidence, special care must be given to patients with several risk factors. Also, care should be given to proper qualification of patients, use of guidewires, early pre-cut incision, protective Wirsung’s duct stenting, and rectal NSAID administration.

scholarly journals Clinical course of biliary-type sphincter of Oddi dysfunction: endoscopic sphincterotomy and functional dyspepsia as affecting factors

2019 ◽  
Vol 12 ◽  
pp. 263177451986718 ◽  
Author(s):  
Hiroyuki Miyatani ◽  
Hirosato Mashima ◽  
Masanari Sekine ◽  
Satohiro Matsumoto
Keyword(s):  
Functional Dyspepsia ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Sphincterotomy ◽  
Severe Pain ◽  
Sphincter Of Oddi ◽  
Sphincter Of Oddi Dysfunction ◽  
Endoscopic Retrograde ◽  
History Of ◽  
Oddi Dysfunction ◽  
New Onset

Background and study aims: The objective of this study was to clarify the effectiveness of treatment selection for biliary-type sphincter of Oddi dysfunction by severe pain frequency and the risk factors for recurrence including the history of functional gastrointestinal disorder. Patients and methods: Thirty-six sphincter of Oddi dysfunction patients who were confirmed endoscopic retrograde cholangiopancreatography enrolled in this study. Endoscopic sphincterotomy was performed for type I and manometry-confirmed type II sphincter of Oddi dysfunction patients with severe pain (⩾2 times/year; endoscopic sphincterotomy group). Others were treated medically (non-endoscopic sphincterotomy group). Results: The short-term effectiveness rate of endoscopic sphincterotomy was 91%. The final remission rates of the endoscopic sphincterotomy and non-endoscopic sphincterotomy groups were 86% and 100%, respectively. Symptoms relapsed after endoscopic sphincterotomy in 32% of patients. Patients in the endoscopic sphincterotomy and non-endoscopic sphincterotomy groups had or developed functional dyspepsia in 41% and 14%, irritable bowel syndrome in 5% and 14%, and gastroesophageal reflux disorder in 14% and 0%, respectively. History or new onset of functional dyspepsia was related to recurrence on multivariate analysis. The frequency of occurrence of post-endoscopic retrograde cholangiopancreatography pancreatitis and post-endoscopic retrograde cholangiopancreatography cholangitis was high in both groups. Two new occurrences of bile duct stone cases were observed in each group. Conclusion: According to the treatment criteria, endoscopic and medical treatment for biliary-type sphincter of Oddi dysfunction has high effectiveness, but recurrences are common. Recurrences may be related to new onset or a history of functional dyspepsia.

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