THE CLINICAL NEED FOR SPHINCTER OF ODDI MANOMETRY IN GASTROINTESTINALENDOSCOPY UNITS

The clinical need for sphincter of Oddi manometry (SOM) was investigat ed by retrospective analysis of 736 consecutive endoscopic retrograde cholangiopancreatography (ERCP) referrals (1985-89). During this perio d SOM was not performed in any unit in Greece including our own. Assum ing a conservative or a more liberal policy in the utilization of SOM, a biliary and a pancreatic group of patients were established respect ively, depending on the clinical presentation. ERCP was diagnostic in 168/194 (86.6 %) of patients referred for postcholecystectomy symptoms , but SOM was considered to be necessary to establish a diagnosis in t he remaining 26 (13.4 %) patients (biliary group). ERCP revealed pancr eatic and/or biliary pathology in 46/69 (66.7 %) patients, referred fo r symptoms attributed to pancreatitis, but 11/69 (15.9 %) patients wit h pancreas divisum and 12/69 (17.4 %) with acute recurrent idiopathic pancreatitis may have benefitted from SOM for planning endoscopic ther apy (pancreatic group). rhus, only 5 patients from each group per 147 ERCP annual referrals were candidates for SOM. When taking into accoun t that to run a SOM service the minimum annual number of investigation s should be 50 and that the provision of ERCP in the UK is 50 per 100, 000 of population per year, it is extrapolated that such a Gastrointst inal Endoscopy Unit should serve a population of 1.5 to 3 million.