Frequency of abnormal pancreatic and biliary sphincter manometry compared with clinical suspicion of sphincter of Oddi dysfunction

Background: Sphincter of Oddi manometry as performed at ERCP is the most ac cepted method to evaluate for sphincter of Oddi dysfunction. To fully asses s: for sphincter of Oddi dysfunction, both the pancreatic and the bile duct s must be evaluated. We assessed the frequency of pancreatic and biliary sp hincter abnormalities in a large series of patients. Methods: A total of 593 patients underwent manometry of the biliary and pan creatic ducts at one endoscopic retrograde cholangiopancreatography session . Basal sphincter pressure greater than or equal to 40 mm Hg was considered abnormal. Phasic waves were not evaluated. Manometric abnormalities were c orrelated with the clinical presentation as categorized using a modified Ge enen/Hogan classification. Results: Of 360 patients with intact sphincters, 18.9% had abnormal pancrea tic sphincter basal pressure alone, 11.4% had abnormal biliary basal sphinc ter pressure alone, and in 31.4% the basal pressure was abnormal for both s phincters; thus, 60.1% of the patients had sphincter dysfunction. The,frequ ency of sphincter of Oddi dysfunction did-not differ whether typed by bilia ry or pancreatic criteria: approximately 65% type II and 59% type III. Of p atients without pancreatitis, 55.9% had an abnormal basal sphincter pressur e, whereas sphincter dysfunction was present in 72.3% of those with idiopat hic pancreatitis and 53.9% of patients with chronic pancreatitis. Of patien ts with an ablated biliary sphincter, 45.9% had abnormal basal pancreatic s phincter pressure and only;0.6% had an abnormal biliary sphincter pressure alone. Abnormal pressure in both sphincters was found in 9.3%. Conclusion: If both portions of the sphincter of Oddi are studied simultane ously, abnormalities are found very commonly (55% to 72%). Assessment Of bo th Sides of the sphincter is necessary. Classifying patients according to b oth pancreatic and biliary sphincter segments is cumbersome, and may be rep laced by an overall type. Using this-modified classification, the frequency of sphincter of Oddi dysfunction is similar in both type:ll and type III p atients (59% to 67%).