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Digestive Diseases and Sciences

, Volume 44, Issue 2, pp 336–340 | Cite as

Comparison of Ultrasound-Secretin Test and Sphincter of Oddi Manometry in Patients with Recurrent Acute Pancreatitis

  • V. Di Francesco
  • M. P. Brunori
  • L. Rigo
  • J. Toouli
  • G. Angelini
  • L. Frulloni
  • P. Bovo
  • M. Filippini
  • B. Vaona
  • G. Talamini
  • G. Cavallini
Article

Abstract

Manometry is considered the gold standard forevaluating sphincter of Oddi dysfunction. It hasrecently been demonstrated that the ultrasound (US)secretin test proposed a few years ago as a noninvasive test for the study of sphincter of Oddidysfunction yields a substantial percentage ofpathological findings in patients with acute recurrentpancreatitis. The aim of this study was to compare theresults of the US secretin test with sphincter of Oddimanometry findings in a consecutive series of patientswith recurrent acute pancreatitis. Forty-seven patientsadmitted to our gastrointestinal unit suffering from recurrent acute pancreatitis underwentultrasonographic measurement of the main pancreatic ductat baseline and for 60 min after maximal stimulationwith secretin at 1 IU/kg. According to the US secretin test findings in 35 healthy control subjects,the test results were considered to indicate pathologywhen the duct was still dilated after 20 min. Withinthree to seven days the same patients underwent perendoscopic manometry. Thirty-six patients(17 men, 19 women; mean age 41 ± 15 years) had asuccessful US secretin test and sphincter of Oddimanometry. Eleven patients (30.6%) presented normalmanometric findings. Two of these had an abnormal USsecretin test. Twenty-five patients had abnormalmanometry findings, revealing stenosis in 19 (52.7%) (17with abnormal US secretin test) and dyskinesia in six (five with an abnormal US secretin test).Compared to manometry findings, the US secretin testsensitivity and specificity for sphincter of Oddidysfunction were 88% and 82%, respectively. Inconclusion, most patients with recurrent acute pancreatitishave sphincter of Oddi dysfunction documented by both atthe US secretin test and sphincter of Oddi manometry;results of the US secretin test are reliable compared to sphincter of Oddi manometry, andtherefore the US secretin test may offer a validalternative to the more expensive and invasivemanometric procedure for assessing sphincter of Oddidysfunction in patients with recurrent acutepancreatitis.

SPHINCTER OF ODDI DYSFUNCTION MANOMETRY ACUTE PANCREATITIS ULTRASOUND SECRETIN TEST 

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REFERENCES

  1. 1.
    Allesher HD: Papilla of Vater: structure and function. Endoscopy 21:324–329, 1989Google Scholar
  2. 2.
    Sherman S, Troiano FP, Hawes RH, O'Connor KW, Lehman GA: Frequency of abnormal sphincter of Oddi manometry compared with clinical suspicion of sphincter of Oddi dysfunction. Am J Gastroenterol 86:586–590, 1991Google Scholar
  3. 3.
    Geenen JE, Hogan WJ, Doods WJ, Toouli J, Venu RP: The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter of Oddi dysfunction. N Engl J Med 320:82–87, 1989Google Scholar
  4. 4.
    Venu RP, Geenen JE, Hogan W, Stone J, Johnson GK, Soergel K: Idiopathic recurrent pancreatitis. An approach to diagnosis and treatment. Dig Dis Sci 34:56–60, 1989Google Scholar
  5. 5.
    Toouli J, Roberts-Thompson IC, Dent J, Lee J: Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis. Br J Surg 72:859–863, 1985Google Scholar
  6. 6.
    Warshaw L: Idiopathic recurrent pancre atitis: Opinion from USA. In Facing Pancreatic Dilemma. P Pederzoli, G Cavallini, C Bassi (eds). Berlin, Springer-Verlag, 1994, pp 75–83Google Scholar
  7. 7.
    Hogan WJ: The role of sphincter of Oddi in pancreaticobiliary disorders. In Motor Disorders of the Gastrointestinal Tract: What's New and What To Do. RS Fisher, B Krevsky (eds).New York, Academy Professional Information Services, 1993, pp 79–83Google Scholar
  8. 8.
    Raddawi HM, Geenen JE, Hogan WJ, Doods WJ, Venu RP, Johnson GK: Pressure measurements from biliary and pancreatic segments of sphincter of Oddi. Comparison between patients with functional abdominal pain, biliary or pancreatic disease. Dig Dis Sci 36:71–74, 1991Google Scholar
  9. 9.
    Thune A, Scicchitano J, Roberts-Thomson IC, Toouli J: Reproducibility of endoscopic sphincter of Oddi manometry. Dig Dis Sci 36:1401–1405, 1991Google Scholar
  10. 10.
    Rolny P, Anderberg B, Ihse I, Lindstrom E, Olaison G, Arvill A: Pancreatitis after sphincter of Oddi manometry. Gut 31:821–824, 1990Google Scholar
  11. 11.
    Scicchitano J, Saccone GT, Baker RA, Roberts-Thomson IC, Toouli J: How safe is endoscopic sphincter of Oddi manometry? J Gastroenterol Hepatol 10:334–336, 1995Google Scholar
  12. 12.
    Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM: Complications of endoscopic biliary sphincterotomy. N Engl J Med 335:909–918, 1996Google Scholar
  13. 13.
    Bolondi L, Gaiani S, Gullo L, LaboÁ G: Secre tin administration induces a dilatation of main pancreatic duct. Dig Dis Sci 29:802–808, 1984Google Scholar
  14. 14.
    Warshaw AL, Simeone J, Schapiro RH, Hedberg, Mueller PE, Ferrucci JT: Objective evaluation of ampullary stenosis with ultrasonography and pancreatic stimulation. Am J Surg 149:65–72, 1985Google Scholar
  15. 15.
    Cavallini G, Rigo L, Bovo P, Brunori MP, Angelini G, Vaona B, Di Francesco V, Frulloni L, Cocco C, Perobelli L: Abnormal US response of main pancreatic duct after secretin stimulation in patients with acute pancreatitis of differentetiology. J Clin Gastroenterol 18:298–303, 1994Google Scholar
  16. 16.
    Castellani C, Bonizzato A, Cipolli M, Sgarbi D, Cavallini G, Di Francesco V, Bassi C, Pederzoli P, Mastella G: CFTR mutations and IVS8–5T prevalence in idiopathic chronic and acute recurrent pancreatitis. Ital J Gastroenterol Hepatol 29(S2): a17, 1997 (abstract)Google Scholar
  17. 17.
    Carr-Locke DL, Gregg JA, Chey WY: Effects of exogenous secretin on pancreatic and biliary ductal and sphincteric pressures in man demonstrated by endoscopic manometry and correlation with plasma secretin level. Dig Dis Sci 30:909–917, 1985Google Scholar
  18. 18.
    Ros E, Navarro S, Bru C, Garcia-Puges A, Valderrama R: Occult microlithiasis in “idio-pathic” acute pancreatitis: Prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Gastroenterology 101:1701–1709, 1991Google Scholar
  19. 19.
    Corazziari E, Cicala M, Habib FI, Scopinaro F, Fiocca F, Pallotta N, Viscardi A, Vignoni A, Torsoli A: Hepatoduodenal biletransit in cholecystectomized subjects. Dig Dis Sci 39:1985–1993, 1994Google Scholar

Copyright information

© Plenum Publishing Corporation 1999

Authors and Affiliations

  • V. Di Francesco
  • M. P. Brunori
  • L. Rigo
  • J. Toouli
  • G. Angelini
  • L. Frulloni
  • P. Bovo
  • M. Filippini
  • B. Vaona
  • G. Talamini
  • G. Cavallini

There are no affiliations available

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