Complications of sphincter of Oddi manometry: biliary-like pain versus acute pancreatitis.
OBJECTIVE
Although acute pancreatitis is the most significant complication of sphincter of Oddi manometry (SOM), acute biliary-like abdominal pain--similar or identical to the patient's usual recurrent acute episodes of pain and not fulfilling clinical criteria for acute pancreatitis--can also be provoked by SOM. The aim of the article is to determine and compare the relative frequency of occurrence of, and risk factors for, post-manometry biliary-like abdominal pain and post-manometry pancreatitis.


METHODS
The clinical and laboratory features, the manometric recordings from the sphincter of Oddi, and the immediate post-manometry outcomes, were examined in 234 consecutive patients undergoing sphincter of Oddi manometry at our Unit.


RESULTS
Post-manometry pancreatitis occurred in 9% of patients, and was associated with two risk factors on multivariate analysis: a history of post-ERCP pancreatitis (odds ratio [OR] 5.9) and a raised basal sphincter pressure (> or =40 mmHg) at SOM (OR 3.5). An increased sphincter phasic wave frequency (> or =7/min) at SOM was identified as a significant (p<0.05) risk factor on univariate testing only. Post-manometry biliary-like pain occurred in 12% of patients, and was associated with 3 different risk factors on multivariate analysis: age below 50 years (OR 4.6); less than a 2-year history of recurrent abdominal pain (OR 3.0); and ERCP and/or ES carried out during the SOM procedure (OR 9.3).


CONCLUSIONS
Provocation of biliary-like pain following SOM, without clinical evidence of pancreatitis, occurs at least as frequently as post-manometry acute pancreatitis. In contrast to post-manometry pancreatitis, post-manometry biliary-like pain occurs more often in younger patients with a shorter duration of symptoms and does not appear related to the manometric features of the sphincter documented at SOM; we propose that this clinical entity may reflect the presence of bile duct or duodenal hypersensitivity/hyperalgesia.
Wong
Grace S W
GS
Department of Gastroenterology, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
Teoh
Narcissus
N
Dowsett
John D
JD
Bell
Cameron J
CJ
Kellow
John E
JE
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D003085:Colic / Q000209:etiology*; D003137:Common Bile Duct Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000009:adverse effects*; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D011183:Postoperative Complications; D012307:Risk Factors; D009803:Sphincter of Oddi / Q000503:physiopathology*