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South Med J. 2013 May;106(5):298-302. doi: 10.1097/SMJ.0b013e318290c6be.

Risk stratification for the development of post-ERCP pancreatitis by sphincter of Oddi dysfunction classification.

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1
Division of Gastroenterology and Hepatology, Departments of Internal Medicine and Pharmacology and Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.

Abstract

OBJECTIVES:

To explore whether there is a difference in the frequency of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in patients with manometrically confirmed sphincter of Oddi dysfunction (SOD) types I, II, and III.

METHODS:

A retrospective review of all of the patients who underwent an ERCP with SOD type I or patients with manometrically confirmed SOD type II or type III (mean basal sphincter pressure ≥ 40 mm Hg) from 2006 to 2010 was performed. The primary outcome measure was development of post-ERCP acute pancreatitis in each of the SOD groups. Factors associated with acute pancreatitis in each group were examined by univariate analysis.

RESULTS:

We identified 147 patients with SOD. Biliary sphincterotomy was performed in all of the patients, and pancreatic sphincterotomy was performed in 68 of the 147 (46%). All of the patients underwent stenting of the pancreatic duct. Post-ERCP pancreatitis occurred in 23% of the study cohort. Patients with SOD type III had a higher frequency of post-ERCP pancreatitis compared with the SOD type I and type II groups (31% vs 20% vs 6%, respectively; P = 0.024). Those with SOD type III had a greater frequency of post-ERCP pancreatitis (odds ratio 6.7; P = 0.05) compared with those with SOD type I. Patients with SOD type III had a two times greater frequency of developing post-ECRP pancreatitis compared with those with SOD type II.

CONCLUSIONS:

SOD type III is strongly associated with the development of post-ERCP pancreatitis compared with SOD type I.

PMID:
23644636
DOI:
10.1097/SMJ.0b013e318290c6be
[Indexed for MEDLINE]
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