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).