Division of Gastroenterology/Hepatology, Clarian/IU Digestive Diseases Center, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Endoscopy. 2010 May;42(5):369-74. doi: 10.1055/s-0029-1215374. Epub 2009 Dec 4.
Sphincter of Oddi manometry (SOM), performed at endoscopic retrograde cholangiopancreatography (ERCP), is the gold standard for diagnosing sphincter of Oddi dysfunction (SOD). The question remains as to whether the short-term manometric recordings reflect the 24-hour pathophysiology of the sphincter. The aim of this study was to determine the frequency of SOD in persistently symptomatic patients with previously normal SOM studies.
All patients who underwent ERCP for suspected SOD over a 13-year period (1994 - 2007) were considered for inclusion in the study. Patients with an intact papilla and a previously normal SOM who had a repeat ERCP for persistent symptoms formed the study group. SOM was performed in conventional retrograde fashion.
In all, 5352 patients without prior papillary intervention underwent SOM during the study period. A total of 1037 patients had normal SOM, and of these, 30 patients (27 female, mean age 40.1 years) underwent repeat ERCP for persistent symptoms. The median duration between the two ERCPs was 493.5 days (range 52-3538 days). In these 30 patients, SOD classification prior to the initial ERCP was: type I in one patient (not treated in 1994), type II in 17 patients, and type III in 12 patients. Of the 30 patients, 12 (40%) had normal SOM at repeat ERCP; SOD was diagnosed in 18/30 (60%) patients.
A single SOM study may not represent the day-to-day physiology of the sphincter of Oddi; sphincter pathology may progress over time. One normal exam may not rule out SOD. A repeat ERCP with manometry may be warranted in a subset of patients with persistent debilitating symptoms and a high index of suspicion for SOD. Outcome data are needed to determine whether this approach justifies the potential risks of ERCP.
Oddi 括约肌测压（SOM）在逆行胰胆管造影（ERCP）下进行，是诊断 Oddi 括约肌功能障碍（SOD）的金标准。目前仍存在争议，即短期测压记录是否能反映括约肌的 24 小时病理生理学变化。本研究旨在确定在先前 SOM 检查正常的持续性症状患者中 SOD 的发生率。
所有在 13 年期间（1994 年至 2007 年）因疑似 SOD 而行 ERCP 的患者均被认为符合纳入研究标准。本研究组为有完整乳头且先前 SOM 正常、因持续性症状而再次行 ERCP 的患者。SOM 以常规逆行方式进行。
在研究期间，共有 5352 例无先前乳头干预的患者接受 SOM。共有 1037 例 SOM 正常，其中 30 例（27 例女性，平均年龄 40.1 岁）因持续性症状再次行 ERCP。两次 ERCP 之间的中位时间为 493.5 天（范围 52-3538 天）。在这 30 例患者中，初次 ERCP 前的 SOD 分类为：1 例（1994 年未治疗）为 I 型，17 例为 II 型，12 例为 III 型。在这 30 例患者中，有 12 例（40%）在重复 ERCP 时 SOM 正常；30 例中有 18 例（60%）被诊断为 SOD。
单次 SOM 研究可能无法代表 Oddi 括约肌的日常生理功能；括约肌的病理变化可能随时间而进展。一次正常检查不能排除 SOD。对于持续性致残症状和高度怀疑 SOD 的患者，可能需要重复进行带有测压的 ERCP。需要有结局数据来确定这种方法是否证明 ERCP 的潜在风险是合理的。
