Long-term results (≥ 10 years) of endoscopic therapy for sphincter of Oddi dysfunction in patients with acute recurrent pancreatitis.
OBJECTIVE
Sphincter of Oddi dysfunction (SOD) is one important cause of idiopathic acute-recurrent pancreatitis (ARP). Several trials have documented complete remission from ARP after endoscopic sphincterotomy during a 2-3-year follow-up. Data with longer follow-up, however, are not available.


METHODS
Between 1995 and 1998, endoscopic sphincterotomy was performed in 37 patients with manometrically documented SOD and ARP. Afterwards, all patients were prospectively re-evaluated over a period of at least 2 years. In 2008, all patients and their primary physicians were contacted and the patients were interviewed using a structured questionnaire. If a case or situation was unclear, the patients were clinically re-evaluated at our hospital.


RESULTS
During the initial prospective 2-year follow-up, relapsing pancreatitis was documented in 5/37 patients (14%). At this point, dual endoscopic sphincterotomy was performed in four patients, and one patient underwent surgical pancreatico-jejunostomy. On retrospective re-evaluation (total follow-up, 11.5±1.6 years) at least one episode of recurrent pancreatitis was found among 19/37 patients (51%). The mean number of relapses that occurred during long-term follow-up (0.7±0.7; range, 0-2) was lower than that recorded at the time of patient enrollment (2.5±0.5; range, 2-4). The recurrence rate did not differ with respect to the patient's first clinical presentation, their demographic data or initial manometric findings. However, relapsing pancreatitis was documented more often in patients who, in the past, had undergone either biliary or pancreatic endoscopic sphincterotomy (12/13 patients) than among those who had undergone dual endoscopic sphincterotomy first (7/24 patients; P<0.05). The median interval for relapsing pancreatitis was 3.5 years (range, 3-84 months).


CONCLUSIONS
Follow-up after endoscopic therapy for SOD in patients with ARP should be considered for at least 5 years. For endoscopic treatment, dual endoscopic sphincterotomy may be preferred, although this will not completely prevent recurrence of pancreatitis. Endoscopic therapy nonetheless helped to decrease the frequency of relapse.
Division of Gastroenterology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany. till.wehrmann@dkd-wiesbaden.de
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D000328:Adult; D003137:Common Bile Duct Diseases / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D009803:Sphincter of Oddi / Q000503:physiopathology / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome