Incidence of pancreatitis in patients undergoing sphincter of oddi manometry (SOM)

Objective: Sphincter of Oddi manometry (SOM) is a useful diagnostic procedu re when evaluating patients with unexplained biliary pain or idiopathic rec urrent pancreatitis. Acute pancreatitis is a recognized complication of SOM hose pathogenesis appears to be multifactoral. We conducted this study to determine the incidence of pancreatitis in patients after SOM and to identi fy any variables that may lead to an increased incidence of pancreatitis. M ethods: A retrospective review of 100 consecutive patients who underwent SO M between 1992 and 1996 at two university-affiliated hospitals was done. SO M was performed using a triple lumen catheter with each lumen perfused at a rate of 0.25 cc/min using an Arndorfer pneumohydraulic capillary perfusion system. The following data were recorded: age, gender, clinical type of sp hincter of Oddi dysfunction, length of procedure, doses of medications used , duct cannulated, sphincter of Oddi pressure, whether endoscopic retrograd e cholangiopancreatography (ERCP) with or without sphincterotomy was perfor med, and the number of patients developing pancreatitis. Statistical analys is was performed using a T test chi(2), and multiple regression analysis. R esults: The overall incidence of pancreatitis was 17%. Six patients with ty pe II SO dysfunction and 11 patients with type III SO dysfunction developed pancreatitis. The incidence of pancreatitis was significantly lower in tho se patients who only had SOM, compared with those patients who had SOM and ERCP (9.3% vs 26.1%,p < 0.026). There was no significant correlation betwee n age, gender, duration of procedure, dose of midazolam used, sphincter of Oddi pressure, or type of SO dysfunction with the development of SOM-induce d pancreatitis. Multiple regression analysis showed that sphincterotomy add ed no additional risk, beyond that associated with ERCP, for the developmen t of pancreatitis. Conclusions: The results of this study indicate that the incidence of pancreatitis was highest when SOM was followed by ERCP. A pot ential method of decreasing the incidence of pancreatitis after SOM is perf orming ERCP with or without sphincterotomy at another session, separated fr om the SOM by at least 24 h. Before this can be definitely recommended, the results of this study must be validated by others or by a prospective stud y. (Am J Gastroenterol 1999;94: 387-390. (C) 1999 by Am. Cell. of Gastroent erology).