Evaluation of Unexplained Acute and Acute Recurrent Pancreatitis Using Endoscopic Retrograde Cholangiopancreatography, Sphincter of Oddi Manometry and Endoscopic Ultrasound

Coyle, W; Pineau, Benoit C.; Tarnasky, PR; Knapple, Whitfield L.; Aabakken, Lars; Bj, Hoffman; Cunningham, J. T.; Hawes, Robert H.; Pb, Cotton

doi:10.1055/s-2002-33245

Cited by 148 publications

(82 citation statements)

References 19 publications

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“…A basal pressure and phasic contractions of Oddi's sphincter could be obtained with OSM. OSM during ERCP is a useful tool in the evaluation of patients with unexplained pancreaticobiliary pain or recurrent idiopathic pancreatitis [5][6][7] . However, it might provoke serious pancreatitis [8,9] .…”

Section: Discussionmentioning

confidence: 99%

Effects of narcotic analgesic drugs on human Oddi’s sphincter motility

Zhang²,

Jin³

et al. 2004

WJG

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AIM:To assess the effects of intramuscular analgesics (morphine, Ap-237, pethidine and tramadol) on human Oddi's sphincter motility with choledochoscope manometry. METHODS:A total of 70 patients having T tubes after cholecystectomy and choledochotomy were assessed by choledochoscope manometry. They were randomly divided into morphine group, Ap-237 group, pethidine group and tramadol group. Basal pressure of Oddi's sphincter (BPOS), amplitude of phasic contractions (SOCA), frequency of phasic contractions (SOF), duration of phasic contractions (SOD), duodenal pressure (DP) and common bile duct pressure (CBDP) were scored and analyzed. All narcotic analgesic drugs were administered intramuscularly. RESULTS:Levels of BPOS, SOCA and SOF were increased after injection of morphine and Ap-237 (P<0.05), level of CBDP was increased from 4.97±3.87 mmHg to 8.62±7.43 mmHg (10 min later) and 7.32±5.95 mmHg (20 min later) after injection of morphine (P<0.01). No apparent change occurred after intramuscular injection of pethidine. Level of BPOS was increased from 7.01±5.50 mmHg to 2.87±2.78 mmHg 10 min after injection of tramadol and SOCA was decreased from 63.34±35.29 mmHg to 45.90±27.86 mmHg (10 min later,P<0.05) and 35.97±24.30 (20 min later,P<0.01) after administration of tramadol. CONCLUSION:All these findings indicate that Oddi's sphincter manometry via choledochoscope is a practical and new way to study the dynamics of Oddi' s sphincter. The regular dose of morphine and Ap-237 could increase BPOS, SOF and SOCA. Morphine could increase the level of CBDP, demonstrating an excitatory effect on the sphincter of Oddi. Pethidine had no effect on Oddi's sphincter motility. Tramadol shows an inhibitory effect on the motility of the sphincter of Oddi and decreases levels of BPOS and SOCA.

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Section: Discussionmentioning

confidence: 99%

Effects of narcotic analgesic drugs on human Oddi’s sphincter motility

Zhang²,

Jin³

et al. 2004

WJG

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“…In a prospective and competitive blinded study in patients with CBD obstruction EUS gave 100% accuracy for the diagnosis of choledocholithiasis; it was also significantly more sensitive than transabdominal ultrasonography or CT [10] . In patients with unexplained ARP the use of EUS with high resolution increases the chances of detecting microlithiasis ( Figure 3), a frequent cause of pancreatitis [2,11,12] . A large study by Frossard et al evaluated 168 patients referred with diagnosis of idiopathic pancreatitis.…”

Section: Microlithiasismentioning

confidence: 99%

“…Cystic lesions that cause duct compression or involvement of the main pancreatic duct tend to cause pancreatitis. EUS identified all tumoral causes in a recent series of 90 patients with undetermined causes of acute or recurrent pancreatitis [2] . Cystic neoplasms of the pancreas are traditionally organized according to the type of lining epithelium since this feature dominates the risk of malignancy and management.…”

Section: Pancreatic Tumorsmentioning

confidence: 99%

“…It is difficult to assess the significance of mild or early changes in the pancreatic duct system and the pancreatic parenchyma, particularly because the normal appearance of the pancreas already varies widely with age. In up to 30% of cases of recurrent acute pancreatitis, it is not possible to establish the etiology of the disease, despite a detailed history and extensive investigations [2] , so as a result the patient is diagnosed as having "idiopathic" ARP.…”

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confidence: 99%

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Endoscopic ultrasonography for evaluating patients with recurrent pancreatitis

Petrone¹,

Arcidiacono²,

Testoni³

2008

WJG

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“…A study by Coyle et al determined the diagnostic utility of ERCP with sphincter of Oddi manometry, bile analysis and EUS in patients with acute and acute recurrent idiopathic pancreatitis [6]. Authors concluded that EUS was useful in detecting biliary disease and anatomic anomalities and valuable in detecting early changes of chronic pancreatitis.…”

Section: Studies On Yield Of Eusmentioning

confidence: 99%

Acute pancreatitis: The acute attack. Acute recurrent pancreatitis

Seewald¹,

Soehendra²

2006

Endoscopy

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Due to the well accessibility of the pancreatobilary system, the potential role of EUS and EUS-FNA in an acute attack of a first episode or recurrent idiopathic pancreatitis seems to be an issue. Since EUS is competing with other imaging modalities such as CT, MRCP and ERCP, the following questions have to be raised.(1) Is there a role for EUS as one of the initial imaging modalities? (2) Can EUS replace other diagnostic procedures, especially ERCP? (3) In which period of the acute attack may EUS and EUS-FNA play a role?The published studies about these issues are quite limited. They mainly focused on the role of EUS in cause finding. A potential issue which has not really been addressed is the role of EUS in the early management of complications of an acute pancreatitis such as pancreatic fluid collections and infection.

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Evaluation of Unexplained Acute and Acute Recurrent Pancreatitis Using Endoscopic Retrograde Cholangiopancreatography, Sphincter of Oddi Manometry and Endoscopic Ultrasound

Cited by 148 publications

References 19 publications

Effects of narcotic analgesic drugs on human Oddi’s sphincter motility

Effects of narcotic analgesic drugs on human Oddi’s sphincter motility

Endoscopic ultrasonography for evaluating patients with recurrent pancreatitis

Acute pancreatitis: The acute attack. Acute recurrent pancreatitis

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