奥迪括约肌
医学
奥迪括约肌功能障碍
队列
胃肠病学
胰腺炎
内科学
急性胰腺炎
作者
Gregory A. Coté,B. Joseph Elmunzer,Haley Nitchie,Richard S. Kwon,Field F. Willingham,Sachin Wani,Vladimir Kushnir,Amitabh Chak,Vikesh K. Singh,Georgios I Papachristou,Adam Slivka,Martin L. Freeman,Srinivas Gaddam,Priya A. Jamidar,Paul R. Tarnasky,Shyam Varadarajulu,Lydia D. Foster,Peter B. Cotton
出处
期刊:Gut
[BMJ]
日期:2024-09-07
卷期号:: gutjnl-332686
标识
DOI:10.1136/gutjnl-2024-332686
摘要
Objective Sphincter of Oddi disorders (SOD) are contentious conditions in patients whose abdominal pain, idiopathic acute pancreatitis (iAP) might arise from pressurisation at the sphincter of Oddi. The present study aimed to measure the benefit of sphincterotomy for suspected SOD. Design Prospective cohort conducted at 14 US centres with 12 months follow-up. Patients undergoing first-time endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy for suspected SOD were eligible: pancreatobiliary-type pain with or without iAP. The primary outcome was defined as the composite of improvement by Patient Global Impression of Change (PGIC), no new or increased opioids and no repeat intervention. Missing data were addressed by hierarchal, multiple imputation scheme. Results Of 316 screened, 213 were enrolled with 190 (89.2%) of these having a dilated bile duct, abnormal labs, iAP or some combination. By imputation, an average of 122/213 (57.4% (95% CI 50.4% to 64.4%)) improved; response rate was similar for those with complete follow-up (99/161, 61.5% (54.0% to 69.0%)); of these, 118 (73.3%) improved by PGIC alone. Duct size, elevated labs and patient characteristics were not associated with response. AP occurred in 37/213 (17.4%) at a median of 6 months post ERCP and was more likely in those with a history of AP (30.9% vs 2.9%, p<0.0001). Conclusion Nearly 60% of patients undergoing ERCP for suspected SOD improve, although the contribution of a placebo response is unknown. Contrary to prevailing belief, duct size and labs are poor response predictors. AP recurrence was common and like observations from prior non-intervention cohorts, suggesting no benefit of sphincterotomy in mitigating future AP episodes.
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