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Treatment of idiopathic recurrent acute pancreatitis

Similar Efficacies of Biliary, With or Without Pancreatic, Sphincterotomy in Treatment of Idiopathic Recurrent Acute Pancreatitis

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The role of sphincter of Oddi manometry in the management of patients with idiopathic recurrent acute pancreatitis requires clarification.

Dr Gregory Coté and colleagues from Indiana, USA evaluated the therapeutic effects of endoscopic sphincterotomy in patients with recurrent acute pancreatitis and the prognostic significance of pancreatic sphincter dysfunction.

The team perofrmed a randomized trial of endoscopic retrograde cholangiopancreatography with sphincter of Oddi manometry for patients with idiopathic recurrent acute pancreatitis. 
 
Patients with pancreatic sphincter dysfunction were assigned randomly to groups that received only biliary sphincterotomy or a combination of biliary and pancreatic sphincterotomy.
 
Patients who underwent normal sphincter of Oddi manometry were assigned randomly to groups that received biliary sphincterotomy or a sham surgery. 

The team's primary outcome was incidence of recurrent acute pancreatitis during the follow-up period.

The researchers also determined the incidence of chronic pancreatitis and analyzed factors associated with recurrence of acute pancreatitis.            
17% of subjects developed chronic pancreatitis
Gastroenterology
The research team discovered that among the 69 patients with sphincter dysfunction, 49% who received biliary sphincterotomy, and 47% who received biliary and pancreatic sphincterotomy had recurrent acute pancreatitis. 

In patients with normal sphincter of Oddi manometry, 27% of those who received biliary sphincterotomy, and 11% of those who received the sham surgery had recurrent acute pancreatitis. 
 
The doctors found that overall, 17% of subjects developed chronic pancreatitis during a median follow-up period of 78 months.
 
The odds of recurrent acute pancreatitis during follow-up evaluation were significantly greater among patients with pancreatic sphincter dysfunction than those with normal sphincter of Oddi manometry, and remained so after adjusting for potential confounders.
 
Dr Coté's team concluded that "Among patients with pancreatic sphincter dysfunction, biliary and pancreatic sphincterotomy and biliary sphincterotomy have similar effects in preventing recurrence of acute pancreatitis." 

"Pancreatic sphincter dysfunction is an independent prognostic factor, identifying patients at higher risk for recurrent acute pancreatitis."

Gastroenterol 2012: 143(6): 1502-1509.e1
06 December 2012

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