Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 02 May 2016

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy 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

 02 May 2016 
Resection of colorectal polyps
 02 May 2016 
Genetic variant that increase NAFLD risk
 02 May 2016 
Mycophenolate mofetil as first-line treatment of autoimmune hepatitis
 29 April 2016 
Crohn's disease associated genes
 29 April 2016 
Simvastatins and survival in cirrhosis
 29 April 2016 
HCV infection in Baby Boomers with Medicare
 28 April 2016 
Diarrheal diseases in children
 28 April 2016 
Racial disparities in survival from colon cancer
 28 April 2016 
Birth outcomes in women with IBD receiving assisted reproduction
 27 April 2016 
Dust mite and human GI tract
 27 April 2016 
Celiac disease in adults
 27 April 2016 
Ultra-short celiac disease
 26 April 2016 
Guidelines for nutrition therapy in hospitalized patients
 26 April 2016 
IBS and microscopic colitis
 26 April 2016 
Polyp detection during colonoscopy
 25 April 2016 
Estrogen deficiency and fibrosis risk in women with NAFLD
 25 April 2016 
Acceptance of Liver transplant center organ offers
 25 April 2016 
Abrupt interruption of beta-blockers in cirrhosis 
 22 April 2016 
Novel method to regenerate the esophagus
 22 April 2016 
Relapse after antiviral treatment in Hep B
 22 April 2016 
Microscopic colitis with NSAIDs and PPIs
 11 April 2016 
Admissions times and outcomes for ERCP cholangitis
 11 April 2016 
Infliximab vs adalimumab in ulcerative colitis
 11 April 2016 
H. pylori in treatment-naïve children
 08 April 2016 
Endoscopic treatment of Crohn's strictures
 08 April 2016 
Nutrition therapy in the hospitalized patient
 08 April 2016 
H.pylori effects on pediatric gastric mucosa
 07 April 2016 
CVD changes after TIPSS
 07 April 2016 
HBV during immunosuppressive therapies
 07 April 2016 
Transanal mesorectal resection for rectal cancer
 06 April 2016 
Adherence to colorectal cancer screening strategies
 06 April 2016 
Duodenal bulb biopsies in childhood celiac disease diagnosis
 06 April 2016 
Lymph node metastasis in early gastric cancer
 05 April 2016 
IBS in the US military
 05 April 2016 
Changes in blood flow in cirrhosis
 05 April 2016 
Colorectal cancer risk with serrated polyps
 04 April 2016 
Noninvasive diagnosis of celiac disease
 04 April 2016 
Metallic vs plastic stents for benign biliary strictures
 04 April 2016 
Adherence to quality indicators improves clinical outcomes in ascites
 01 April 2016 
Prognosis after colorectal cancer resection with peritoneal metastasis
 01 April 2016 
Colorectal cancer risk with non-malignant colonoscopy findings
 01 April 2016 
Intensive enteral nutrition and severe alcoholic hepatitis
 31 March 2016 
Anesthesia services during colonoscopy
 31 March 2016 
Alcohol and glucose tolerance in NAFLD
 31 March 2016 
Management of Barrett’s esophagus
 30 March 2016 
Depression and symptoms in IBS
 30 March 2016 
Electronic learning system for colon capsule endoscopy
 30 March 2016 
Gastric cancer screening
 29 March 2016 
Statins and survival in esophageal cancer
 29 March 2016 
Infant feeding practices and celiac disease
 25 March 2016 
Medical therapy and neoplasia regression in familial adenomatous polyposis
 25 March 2016 
Medical therapy compliance and ulcerative colitis recurrence
 25 March 2016 
Predicting outcomes of drug-induced acute liver failure
 24 March 2016 
Thrombocytopenia and multi-organ system failure in acute liver failure
 24 March 2016 
Patients with ulcerative colitis and their concerns
 24 March 2016 
Prediction of relapses in IBD
 23 March 2016 
Thiopurine therapy in IBD
 23 March 2016 
Early colonoscopy for lower GI bleeds
 23 March 2016 
Treatment with immunomodulators and biologics in ulcerative colitis
 22 March 2016 
Bile acid diarrhea

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2016 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us