PANCREATIC SPHINCTER HYPERTENSION INCREASES THE RISK OF POST-ERCP PANCREATITIS

Background and Study Aims: The reason for the increased risk of pancre atitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with sphincter of Oddi dysfunction is not known. This study s ought to determine whether pancreatic sphincter hypertension might exp lain some of the increased risk.Patients and Methods: The incidence of pancreatitis was determined from a cohort of patients who underwent p ancreatic sphincter manometry. Additional data collected included: pan creatic and biliary sphincter manometry results, distal bible duct dia meter, chronic pancreatitis grade by pancreatography, and endoscopic t reatments. Results: Ten of 32 patients (31%) with pancreatic sphincter hypertension developed post-ERCP pancreatitis, compared to one of 33 (3%) with normal pancreatic manometry (P = 0.002). Patient with pancre atic sphincter hypertension were more likely to undergo endoscopic tre atments (88%) compared to those with normal manometry (27%) (P = 0.001 ). The distal bile duct diameter was significantly smaller (4.5 +/- 0. 5 mm) in patients who developed post-ERCP pancreatitis than in those w ho did not (6.2 +/- 0.3) (P = 0.025). Patients with small distal bile duct diameters (< 5 mm) were three times more likely to develop post-E RCP pancreatitis than those with larger ducts (relative risk [RR] 3.1, 95% confidence interval [CI] 0.9, 10.7). Patients with pancreatic sph incter hypertension were ten times more likely to develop post-ERCP pa ncreatitis than those with normal pancreatic manometry (RR 10.3, 95% C I 1.5, 76.0). In patients with a small bile duct size, pancreatic sphi ncter hypertension substantially increased the risk compared to those with normal manometry (RR 18.1, 95% CI 1.1, 287.6). Conclusions: Pancr eatic sphincter hypertension greatly increases the risk of post-ERCP p ancreatitis in patients undergoing treatment or evaluation, or both, f or sphincter of Oddi dysfunction.