Evaluation of unexplained acute pancreatitis using ERCP, sphincter of Oddi manometry (SOM), and endoscopic ultrasound (EUS)

Coyle, Walter; Tarnasky, PR; Knapple, Whitfield L.; Pineau, Benoit C.; Brooker, C; Hoffman, Brenda J.; Aabakken, Lars; Cunningham, J; Pb, Cotton; Hawes, Robert H.

doi:10.1016/s0016-5107(96)80347-6

Cited by 3 publications

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“…Further, a positive secretin test was associated with a favourable clinical outcome after surgical sphincteroplasty 31 . By direct measurement of sphincter of Oddi motor function with endoscopic manometry, sphincter of Oddi was found in 15–72% of such patients 3 –13 . Recurrent pancreatitis can result from dysfunction of the biliary sphincter segment, the pancreatic sphincter zone, or both 6 , .…”

Section: Discussionmentioning

confidence: 99%

“…Among the various aetiologies about two‐thirds of the cases can be attributed to biliary tract disease or ethanol abuse 1 , . 2 Sphincter of Oddi dysfunction, defined by a sphincter baseline pressure ≥ 40 mmHg, was found at endoscopic sphincter of Oddi manometry in 15–72% of patients with acute recurrent pancreatitis of otherwise unknown origin (so called ‘idiopathic’ recurrent pancreatitis) 3 –13 . Perfusion manometry of the pancreatic duct, however, is associated with a substantial risk to induce acute pancreatitis (up to 29%) especially when patients with presumed sphincter of Oddi are studied 12 , .…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic injection of botulinum toxin in patients with recurrent acute pancreatitis due to pancreatic sphincter of Oddi dysfunction

Wehrmann

Schmitt

Arndt

et al. 2000

Aliment Pharmacol Ther

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Aim: To evaluate the technical feasibility, safety, and short‐term efficacy of botulinum toxin injection for pancreatic sphincter of Oddi dysfunction and to analyse whether the symptomatic response to botulinum toxin might be a predictor of outcome for endoscopic sphincterotomy. Methods: Fifteen consecutive patients (nine female, aged 38 ± 12 years) with frequent attacks (median four) of acute pancreatitis within 6 months, and manometrically proven pancreatic sphincter of Oddi dysfunction underwent endoscopic injection of 100 units of botulinum toxin into the major papilla. All patients underwent prospective follow‐up thereafter and in cases of recurrent pancreatitis manometry this was repeated and pancreatic sphincterotomy was performed. Results: No side‐effects occurred after botulinum toxin injection in any patient. Within 3 months after botulinum toxin treatment, 12 out of 15 patients remained asymptomatic (80% primary response). Only one out of three patients without symptomatic benefit showed continued elevated pancreatic sphincter pressure at manometry and only this patient benefited from pancreatic sphincterotomy later on. Eleven of the 12 patients initially responding to botulinum toxin injection developed a symptomatic relapse 6 ± 2 months after botulinum toxin treatment. These patients then achieved long‐term clinical remission from pancreatic or combined (biliary and pancreatic, n=5) sphincterotomy (median follow‐up, 15 months). Conclusion: Endoscopic botulinum toxin injection into the papilla of Vater is a safe procedure for treatment of pancreatic sphincter of Oddi dysfunction that may provide short‐term relief in about 80% of the patients. Those patients who respond to botulinum toxin may subsequently gain definitive cure from sphincterotomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic injection of botulinum toxin in patients with recurrent acute pancreatitis due to pancreatic sphincter of Oddi dysfunction

Wehrmann

Schmitt

Arndt

et al. 2000

Aliment Pharmacol Ther

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Key issues in sphincter of Oddi dysfunction

Varadarajulu

Hawes

2003

Gastrointestinal Endoscopy Clinics of North America

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Idiopathic Acute Pancreatitis

Kim

Bae

et al. 2003

Journal of Clinical Gastroenterology

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After routine investigations, including a thorough history, routine laboratory study, and noninvasive imaging with transcutaneous ultrasonogram, 10% to 25% of cases of acute pancreatitis have no readily identifiable cause and are termed idiopathic. But modern medicine has made notable advances in uncovering various causes of acute pancreatitis, and several new diagnostic tools that allow clinicians to less invasively approach the patient without sacrificing the diagnostic yield have been introduced. By being knowledgeable of these new changes and by their proper use in a proper circumstances, clinicians will be able to find the cause more accurately and earlier. This better management will not only improve the well-being of the patients but also reduce the number of "true" idiopathic acute pancreatitis to a minimum.

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Evaluation of unexplained acute pancreatitis using ERCP, sphincter of Oddi manometry (SOM), and endoscopic ultrasound (EUS)

Cited by 3 publications

References 0 publications

Endoscopic injection of botulinum toxin in patients with recurrent acute pancreatitis due to pancreatic sphincter of Oddi dysfunction

Endoscopic injection of botulinum toxin in patients with recurrent acute pancreatitis due to pancreatic sphincter of Oddi dysfunction

Key issues in sphincter of Oddi dysfunction

Idiopathic Acute Pancreatitis

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