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Biliary sphincterotomy similarly impacted recurrent acute pancreatitis with, without pancreatic sphincterotomy
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Patients with idiopathic recurrent acute pancreatitis had similar outcomes after receiving biliary sphincterotomy with or without pancreatic sphincterotomy in a recent study.
The study included 89 patients with acute pancreatitis who underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincter of Oddi manometry (SOM). Within this cohort, researchers randomly assigned 69 patients with pancreatic sphincter of Oddi dysfunction (SOD) to subsequently receive either biliary sphincterotomy (BES; n=33) or BES in combination with pancreatic sphincterotomy (DES; n=36). Twenty patients who had normal SOM were randomly assigned to receive BES (n=11) or sham surgery (n=9).
During a follow-up period of 1 to 10 years, recurrent acute pancreatitis (RAP) occurred in 37 participants, including 48.5% of those with SOD who received BES and 47.2% of patients who underwent DES (P=1.0 for difference). Among normal SOM patients, acute pancreatitis occurred in 27.3% of BES recipients (P=1.0)and 11.1% of those who underwent sham surgery (P=.59). Repeat ERCP was necessary in most patients with SOD, regardless of receiving BES (94.1% of cases) or DES (76.9%) (P=.17 for difference).
Chronic pancreatitis occurred in 16.9% of the entire cohort, over a median follow-up of 78 months. The likelihood of developing the condition was similar between those with normal SOM and SOD (20% vs. 15.9%, P=.74).
Patients with SOD were significantly more likely to experience RAP than those with normal SOM after adjusting for confounders (HR=4.3; 95% CI, 1.3-14.5). Other factors independently associated with RAP included development of chronic pancreatitis (HR=3.5; 95% CI, 1.7-7.1) and experiencing post-ERCP pancreatitis following initial procedure (HR=5.8; 95% CI, 2.4-14.0).
“Pancreatic sphincterotomy in combination with biliary sphincterotomy was no better than biliary sphincterotomy alone in eliminating the risk of future episodes,” researcher Gregory A. Coté, MD, MS, assistant professor of medicine in the division of gastroenterology at Indiana University School of Medicine, told Healio.com. “Either the pancreatic sphincterotomy that we’re performing is inadequate … or, more likely, sphincter hypertension is not a cause for RAP, but a consequence of recurring inflammation in a more aggressive subgroup of these patients.
“This study has given us more clarity with regard to pancreatic sphincterotomy: At this point, it cannot be recommended as a form of treatment for patients with unexplained RAP.”
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