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Biliary manometry is a low yield investigation in patients with recurrent biliary pain after endoscopic biliary sphincterotomy , but recurrent pancreatitis in this population may reflect previously undiagnosed pancreatic sphincter hypertension



Biliary manometry is a low yield investigation in patients with recurrent biliary pain after endoscopic biliary sphincterotomy , but recurrent pancreatitis in this population may reflect previously undiagnosed pancreatic sphincter hypertension



Digestive Disease Week Abstracts & Itinerary Planner : Abstract No T1556



Aims: Patients with recurrent "biliary" pain after EBS are often sent back to the endoscopist for further evaluation. Biliary +- pancreatic (panc) manometry (mano) is usually requested. We reviewed our experience of such pts at a tertiary center over 2 years. Pts and Methods: Endoscopy and med records of pts with recurrent pain after EBS who returned for repeat ERCP with biliary +- panc mano between 11/99 and 09/02 were reviewed. Those with recurrent CBD stones were excluded. Clinical details, serology (LFTs, amylase, lipase), prior therapies, endoscopic findings, mano results, endotherapy and complications were recorded. Results: 58 pts had undergone prior EBS (8 also had panc sphincterotomy (EPS)). 46/58(79%) were female. Age range: 18-71 yrs (mean: 45.8). Biliary mano was performed in 31/58 pts and was abnormal in only 6/31, all of whom had visible stenosis of the prior EBS. Panc mano was done in 38/58 pts and elevated in 20(53%). 3 of these 20pts had visible stenosis of the prior EBS. 16/20 pts with panc sphincter HTN presented with pancreatitis (Px) : the other 4 had abdo pain only. Sphincterotomy (Sphinc) was performed in 26 pts (20 panc, 6 biliary). 8/58(12%) pts developed post-ERCP Px. Factors significantly associated with biliary or panc sphincter HTN were: visible stenosis of prior EBS, and presentation with recurrent Px. Not predictive of sphincter HTN: sex, race, dilated CBD or panc duct, abdo pain without Px, elevated LFTs. Recent Px predicted post-ERCP Px. Conclusion: In the absence of visible Sphinc site stenosis, biliary mano is likely to be normal in pts with recurrent abdo pain after EBS. However, in those with recurrent pancreatitis, panc sphincter HTN is found in about 1/2 the cases.

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Accession: 034482128

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