Help
Subscribe


Submit Videos to GastroHep Read For FREE - Our full range of review articles
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Guido Tytgat Profile of Pete Peterson Profile of Peter Cotton Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Sphincterotomy vs sham does not reduce pain-related disability after cholecystectomy

A team of doctors examine the effect of endoscopic sphincterotomy for suspected sphincter of Oddi dysfunction on pain-related disability following cholecystectomy, reports this weeks issue of the Journal of the American Medical Association.

News image

Abdominal pain after cholecystectomy is common and may be attributed to sphincter of Oddi dysfunction.

Management often involves endoscopic retrograde cholangiopancreatography (ERCP) with manometry and sphincterotomy.

Professor Peter Cotton and colleagues from South Carolina, USA determined whether endoscopic sphincterotomy reduces pain, and whether sphincter manometric pressure is predictive of pain relief.

The team performed a multicenter, sham-controlled, randomized trial involving 214 patients with pain after cholecystectomy without significant abnormalities on imaging or laboratory studies, and no prior sphincter treatment or pancreatitis.

The patients were randomly assigned to undergo sphincterotomy or sham therapy at 7 referral medical centers, with a 1-year follow-up up to 2013.

After ERCP, patients were randomized to sphincterotomy or sham irrespective of manometry findings.
23% in the sphincterotomy group experienced successful treatment
Journal of the American Medical Association

Those randomized to sphincterotomy with elevated pancreatic sphincter pressures were randomized again to biliary or to both biliary and pancreatic sphincterotomies.

The team reported that 72 were entered into an observational study with conventional ERCP managemeny.

The researchers defined success of treatment as less than 6 days of disability due to pain in the prior 90 days both at months 9 and 12 after randomization, with no narcotic use and no further sphincter intervention.

The team found that 37% of patients in the sham treatment group vs 23% in the sphincterotomy group experienced successful treatment.

Of the patients with pancreatic sphincter hypertension, 30% who underwent dual sphincterotomy, and 20% who underwent biliary sphincterotomy alone experienced successful treatment.

The research team observed that 26% of patients treated, and 34% of patients in the sham group underwent repeat ERCP interventions.

Manometry results were not associated with the outcome.

The team noted that no clinical subgroups appeared to benefit from sphincterotomy more than others.

Pancreatitis occurred in 11% of patients after primary sphincterotomies, and in 15% in the sham group.

Of the nonrandomized patients in the observational study group, 24% who underwent biliary sphincterotomy, 31% who underwent dual sphincterotomy, and 17% who did not undergo sphincterotomy had successful treatment.

Professor Cotton's team concludes, "In patients with abdominal pain after cholecystectomy undergoing ERCP with manometry, sphincterotomy vs sham did not reduce disability due to pain."

"These findings do not support ERCP and sphincterotomy for these patients."

JAMA 2014;311(20):2101-2109
29 May 2014

Go to top of page Email this page Email this page to a colleague

 28 July 2015

Advanced search
 28 July 2015 
Lifestyle changes after colorectal cancer screening
 27 July 2015 
Fecal microbiota transplantation for severe C. difficile infection
 24 July 2015 
Causes of death in celiac disease
 23 July 2015 
Reduction in H. pylori prevalence
 22 July 2015 
Detection of esophageal eosinophilia and eosinophilic esophagitis
 21 July 2015 

Clinical outcomes for Barrett's esophagus neoplasia

 20 July 2015 
Certolizumab pegol for Crohn's disease
 17 July 2015 

Sexual dysfunction after rectal cancer treatment

 17 July 2015 
Genetic variation and gastric cancer
 17 July 2015 
Colitis associated with anti-CTLA-4 therapy
 16 July 2015 
Hormones and endometrial cancer in Lynch syndrome
 16 July 2015 
Lynch syndrome screening by microsatellite instability
 16 July 2015 
Relapse of IBD after discontinuation of anti-TNF therapy
 15 July 2015 
Aspergillus niger-derived enzymes
 15 July 2015 
Prophylactic omeprazole improves GI symptoms
 15 July 2015 
Risk prediction index for advanced colorectal cancer
 14 July 2015 
Combination therapies for chronic HCV
 14 July 2015 
Interferon- and ribavirin-free treatment regimen for HCV
 14 July 2015 
Cancer surveillance in ulcerative colitis
 13 July 2015 
Colon polyps in chronic inflammatory conditions of the colon
 13 July 2015 
Drugs and occult vs overt upper GI bleeds
 13 July 2015 
Anxiety and depression in functional GI disorders
 10 July 2015 
Daclatasvir in the treatment of chronic HCV
 10 July 2015 
Surveillance intervals to reduce colorectal cancer
 10 July 2015 
Stress and GI symptoms in IBD
 09 July 2015 
Opioid-induced esophageal dysfunction
 09 July 2015 
Predictive factors for metastasis in colorectal cancer
 09 July 2015 
Marker of response to medical therapy in Crohn's
 08 July 2015 

Nucleoside analogue therapy in HBeAg-negative chronic hepatitis B?

 08 July 2015 

Medical education in endoscopy training

 08 July 2015 
Chronic unexplained nausea and vomiting
 07 July 2015 
Anastomotic leak after elective surgery for colonic cancer
 07 July 2015 
Fecal transplantation for ulcerative colitis
 07 July 2015 
Obesity and risk of hepatocellular carcinoma
 06 July 2015 
Fecal microbiota transplantation
 06 July 2015 
Liver Failure–Sequential Organ Failure Scoring System
 06 July 2015 
Future colorectal surgery for metachronous cancers
 03 July 2015 
Tumors with mismatch-repair deficiency
 03 July 2015 
Aptitude of trainees in endoscopic ultrasonography
 03 July 2015 
Extracolonic pathologies in colorectal cancer
 02 July 2015 
Ulcerative colitis prognosis after thiopurines withdrawal
 02 July 2015 
Anastomotic leak and cancer cancer
 02 July 2015 
Health care use by IBD children
 01 July 2015 
Missed gastric cancers
 01 July 2015 
Oral mechanical bowel preparation
 01 July 2015 
Probiotics in IBD
 30 June 2015 
Split-dose preparations vs day-before bowel cleansing regimens
 30 June 2015 
Glucocorticoids and peptic ulcer bleeding
 30 June 2015 
NSAIDs and hearburn symptoms
 29 June 2015 
Prevention of pancreatitis after ERCP
 29 June 2015 
Advances in autoimmune pancreatitis
 29 June 2015 
Rescue therapy in ulcerative colitis
 26 June 2015 

Gene polymorphism in alcoholic liver disease

 26 June 2015 
Dietary fibre–microbiota interactions
 26 June 2015 
Gastritis in celiac disease
 25 June 2015 
Persistent organ failure in acute cholangitis patients
 25 June 2015 
Vitamin D level and primary biliary cirrhosis
 25 June 2015 
Fecal microbiota in pediatric IBD
 24 June 2015 
Fatigue scales for IBD
 24 June 2015 
Mucosal healing tests in ulcerative colitis

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2015 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us