Varadarajulu Shyam, Hawes Robert H, Cotton Peter B
Digestive Disease Center, Medical University of South Carolina, Charleston 29425, USA.
Gastrointest Endosc. 2003 Sep;58(3):341-4. doi: 10.1067/s0016-5107(03)00005-1.
Assessment of sphincter of Oddi motility by manometry is limited to a finite time period, and the presence of a motor disorder that is intermittent may not be documented. This study evaluated the frequency of sphincter of Oddi dysfunction in persistently symptomatic patients with previously normal sphincter of Oddi manometry studies.
A total of 177 patients underwent ERCP for suspected sphincter of Oddi dysfunction and had a normal sphincter of Oddi manometry study (both biliary and pancreatic) over a 5-year period (1996-2001). All patients referred for a second ERCP with sphincter of Oddi manometry for evaluation of persistent symptoms were included in this study.
Of the 177 patients, 12 (mean age 37.6 years, range 19-59 years) met criteria for inclusion. The mean time interval between the first and second ERCP was 337 days (range 43-792 days). Sphincter of Oddi dysfunction was diagnosed at a second sphincter of Oddi manometry in 5 (42%) patients; 4 had pancreatic sphincter hypertension; one had elevation of both pancreatic and biliary sphincter pressures. All 5 patients underwent endoscopic sphincter ablation therapy; 4 were symptom-free on follow-up at, respectively, 26, 40, 48, and 72 months; one patient had persistent symptoms from pancreatic sphincter restenosis and required multiple endoscopic interventions. Five of the 12 (42%) patients with normal manometric studies were found to have pancreatographic changes of chronic pancreatitis; the two remaining patients had a normal ERCP and manometry.
A single negative manometry study does not rule out sphincter of Oddi dysfunction. Repeat ERCP with manometry may be warranted for patients with persistent symptoms in whom the clinical suspicion for sphincter of Oddi dysfunction remains high.
通过测压法评估Oddi括约肌运动功能仅限于有限的时间段，间歇性运动障碍的存在可能无法被记录。本研究评估了既往Oddi括约肌测压研究正常但症状持续的患者中Oddi括约肌功能障碍的发生率。
在5年期间（1996 - 2001年），共有177例因疑似Oddi括约肌功能障碍接受内镜逆行胰胆管造影（ERCP）且Oddi括约肌测压研究（包括胆管和胰管）正常的患者。所有因持续症状而被转诊进行第二次带Oddi括约肌测压的ERCP评估的患者均纳入本研究。
177例患者中，12例（平均年龄37.6岁，范围19 - 59岁）符合纳入标准。第一次和第二次ERCP之间的平均时间间隔为337天（范围43 - 792天）。在第二次Oddi括约肌测压时，5例（42%）患者被诊断为Oddi括约肌功能障碍；4例有胰管括约肌高压；1例胰管和胆管括约肌压力均升高。所有5例患者均接受了内镜括约肌切除术治疗；4例分别在随访26、40、48和72个月时无症状；1例患者因胰管括约肌再狭窄而持续有症状，需要多次内镜干预。12例测压研究正常的患者中有5例（42%）发现有慢性胰腺炎的胰管造影改变；其余2例患者ERCP和测压均正常。
单次阴性测压研究不能排除Oddi括约肌功能障碍。对于临床高度怀疑Oddi括约肌功能障碍且症状持续的患者，可能有必要重复进行带测压的ERCP。
