Secretin MRCP and endoscopic pancreatic manometry in the evaluation of sphincter of Oddi function: a comparative pilot study in patients with idiopathic recurrent pancreatitis

Mariani, Alberto; Curioni, Simona; Zanello, Alessandro; Passaretti, Sandro; Masci, E.; Rossi, Marzia; Maschio, Alessandro Del; Testoni, Pier Alberto

doi:10.1016/s0016-5107(03)02303-4

Cited by 87 publications

(38 citation statements)

References 29 publications

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“…With the advent of secretin MRCP, aetiologies such as SOD and PD which were earlier diagnosed only by ERCP, can well be diagnosed by MRCP, as shown by Mariani et al 80 Other aetiologies which can be picked up by MRCP include occult biliary tumours, congenital anomaly of the pancreas, and bile duct stones. 81 Secretin MRCP is also a good modality to diagnose early CP.…”

Section: Phase II Investigationsmentioning

confidence: 99%

Recurrent acute pancreatitis: an approach to diagnosis and management

Kedia¹,

Dhingra²,

Garg³

2013

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Recurrent acute pancreatitis (RAP) is defined as more than two attacks of acute pancreatitis (AP) without any evidence of underlying chronic pancreatitis (CP). As the known causes of AP are generally taken care of, RAP usually occurs in the idiopathic group, which forms 20%- In general, empirical cholecystectomy should be discouraged with the availability and widespread use of EUS. Endoscopic sphincterotomy is advised if there is strong suspicion of SOD. Minor papilla sphincterotomy should be carried out in those with PD but with limited expectations. Regular follow-up of patients with IRAP is necessary because most patients are likely to develop CP in due course.

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Section: Phase II Investigationsmentioning

confidence: 99%

Recurrent acute pancreatitis: an approach to diagnosis and management

Kedia¹,

Dhingra²,

Garg³

2013

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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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“…The strength of secretin-enhanced MRCP in this setting is the lack of invasiveness; however, the weakness is the reduced accuracy compared with that of manometry. Studies reported a global sensitivity of secretin-enhanced MRCP of 37%-57.1% and a specificity of 85%-100% (27,(40)(41)(42); better accuracies were reported in types I and II sphincter of Oddi dysfunction (73%) compared with type III (46%) (41).…”

Section: Recurrent Episodes Of Acute Pancreatitismentioning

confidence: 99%

Secretin-enhanced MR Imaging of the Pancreas

Manfredi¹,

Mucelli²

2016

Radiology

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1Secretin is a hormone that stimulates the exocrine pancreatic secretion of bicarbonate-rich fluid from the acinar cells of the pancreas that accumulates within the pancreatic ductal lumen. The exogenous administration of secretin improves the visualization of pancreatic ducts at magnetic resonance (MR) cholangiopancreatography (MRCP), because of an enlargement of the pancreatic duct system and an increase of the fluid content within the lumen of the pancreatic ducts, responsible of an increase of MR signal. In this review, the technique of secretin-enhanced MRCP, which has the aim to depict the whole pancreatic duct system, the biliary tree, the major and minor papillae, and the duodenum, will be described. Because of the anatomic contiguity between the pancreas and the gastrointestinal tract, the presence of fluid within the stomach may overlap with the pancreatic duct system and therefore the pancreatic duct may be difficult to visualize, representing a potential source of diagnostic pitfalls. The technique to reduce the signal intensity of the static fluid present within the stomach and in the duodenal lumen is also described. The technique of secretin administration will be illustrated, with emphasis on the synchronization of secretin administration and MR image acquisition. Furthermore, the frequency and number of MRCP images necessary to achieve a temporal resolution adequate to visualize the physiologic changes in the pancreatic gland, induced by the administration of secretin, is described. The assessment of pancreatic, morphologic, and functional response to the administration of secretin, as depicted on MRCP images, will be illustrated. Finally, the indications for secretin-enhanced MRCP will be discussed to define which patients will benefit from secretin-enhanced MR imaging for their treatment planning. © RSNA, 2016 This copy is for personal use only. To order printed copies, contact reprints@rsna.org I n recent years, magnetic resonance (MR) imaging has increased its role in the detection and characterization of pancreatic diseases. This is most likely due to the capability of MR imaging to simultaneously assess the pancreatic parenchyma and the pancreatic and bile duct systems. This can be achieved by obtaining cross-sectional MR images by using breath-hold T1-weighted gradient-echo sequences performed as two-or three-dimensional gradient-echo, fat-suppression techniques; T2-weighted half-Fourier pulse sequences; diffusion-weighted imaging; and dynamic contrast material-enhanced imaging following the administration of gadolinium chelates that are able to depict and characterize focal pancreatic masses and evaluate diffuse pancreatic diseases. Furthermore, MR cholangiopancreatography (MRCP) is STATE OF THE ART: Essentialsn Secretin-enhanced magnetic resonance cholangiopancreatography (MRCP) is indicated in patients with chronic asymptomatic hyperenzymemia, recurrent acute pancreatitis, sphincter of Oddi dysfunction, anatomic variants, chronic pancreatitis, and main pancreatic duct stenosis.n Se...

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Secretin MRCP and endoscopic pancreatic manometry in the evaluation of sphincter of Oddi function: a comparative pilot study in patients with idiopathic recurrent pancreatitis

Cited by 87 publications

References 29 publications

Recurrent acute pancreatitis: an approach to diagnosis and management

Recurrent acute pancreatitis: an approach to diagnosis and management

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

Secretin-enhanced MR Imaging of the Pancreas

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