Source: Sao Paulo Med J  |  Posted 9 years ago

Endoscopic retrograde cholangiopancreatography (ERCP), bile analysis and sphincter of Oddi manometry identify an underlying cause in most patients suffering from idiopathic recurrent pancreatitis, which is treatable in around three-quarters of cases.

Researchers from the Medical College of Ohio, Toledo, and Allegheny General Hospital, Pittsburgh, enrolled 126 patients suffering from idiopathic recurrent pancreatitis. Patients in whom ERCP was normal underwent manometry of the sphincter of Oddi and their bile was analysed for microcrystals. The authors also analysed bile samples taken from patients with papillary stenosis.

These assessments detected abnormalities in 79 percent of patients. ERCP alone detected an underlying cause in 37 percent of cases. Papillary stenosis accounted for 21 percent of cases. Pancreas divisum and choledocholithiasis accounted for 7 and 5 percent of cases respectively. Half the patients with a gallbladder showed microcrystals, while 31 percent expressed sphincter dysfunction. Forty-seven percent of patients who underwent cholecystectomy showed sphincter dysfunction.

Ninety-three of 100 patients in whom one of the tests detected an abnormality underwent endoscopic sphincterotomy. Eight of the nine patients with pancreas divisum underwent minor papilla sphincterotomy. Eighty-five patients with choledocholithiasis, choledochocele, microcrystals, papillary stenosis or sphincter dysfunction underwent biliary sphincterotomy. Two other patients with microcrystals underwent cholecystectomy. Seventy-eight and 23 percent of patients with pancreatic sphincter hypertension and papillary stenosis with dilated pancreatic ducts respectively underwent pancreatic sphincterotomy. Response rates varied between 67 and 100 percent over the follow up lasting between 18 and 33 months (mean 29.6 months).

The authors concluded that ERCP, including minor papilla cannulation, analysing bile for microcrystals and manometry of the sphincter of Oddi identified a cause in most patients suffering from idiopathic recurrent pancreatitis. This underlying cause can be treated endoscopically in around three-quarters of cases.