Gk Johnson

Pressure measurements from biliary and pancreatic segments of sphincter of oddi : comparison between patients with functional abdominal pain, biliary, or pancreatic disease

Using a minimally compliant infusion system and a triple-lumen pressure recording catheter, we obtained endoscopic manometric measurements from both the common bile duct and pancreatic duct segments of the sphincter of Oddi (SO) in 58 patients. Fifteen patients (ages 27–69) had the diagnosis of functional abdominal pain, 19 patients (ages 30–76) had partial biliary obstruction, and 24 patients (ages 15–80) had idiopathic acute recurrent pancreatitis. Resting ductal pressure was similar in the common bile duct and pancreatic duct in all patient groups. In the group with functional pain, basal SO pressure was similar, whether obtained from the common bile duct or pancreatic duct sphincteric segment. Eight of 19 patients with partial biliary obstruction had elevated basal SO pressure. Five of these eight patients had elevated basal SO pressure confined exclusively to the common bile duct segment of the sphincter, while three patients had elevated basal SO in both segments. Conversely seven of 24 patients with acute recurrent pancreatitis had an elevated basal SO pressure, with five patients having pressure elevation only in the pancreatic duct segment while two patients had abnormal basal SO pressure in both segments. We conclude that selective cannulation of the common bile duct and/or the pancreatic duct during manometric study of the SO is necessary in order to diagnose segmental SO dysfunction responsible for partial biliary obstruction or episodes of acute recurrent pancreatitis.

Clinical experience in 82 patients with pancreas divisum: preliminary results of manometry and endoscopic therapy.

Although it is clear that the majority of patients with pancreas divisum have no clinical disease, there is a subset of patients who have either unexplained abdominal pain or recurrent pancreatitis. Endoscopic therapy of the minor papilla may alter the clinical course of those patients with pancreas divisum and recurrent pancreatitis. Manometric study of the minor papilla is feasible and reveals a sphincter mechanism similar to the major papilla. Clinical response to endoscopic therapy may aid in selecting patients who might benefit from surgical sphincteroplasty. Refinement of manometric study of the minor papilla offers a potential method of detecting functional obstruction of dorsal duct drainage.

Small intestinal disease, folate deficiency anemia, and oral contraceptive agents.

Two females without obvious symptoms of small intestinal disease presented with severe folate-deficiency anemia, initially attributed to oral contraceptive medication. Folate deficiency, however, developed again after the oral contraceptive had been discontinued. One patient was found to have subclinical idiopathic sprue and the other regional enteritis. In view of this experience it is suggested that patients who develop folate deficiency anemia while taking oral contraceptives be carefully investigated regarding dietary habits, drug therapy, and the presence of unsuspected small bowell disease.

ERCP induced acute pancreatitis: Risk assessment based on diagnostic and specific therapeutic cases

ERCP INDUCED ACUTE PANCREATITIS: RISK ASSESSMENT BASED ON DIAGNOSTIC AND SPECIFIC THERAPEUTIC CASES. MF Catalano, JE Geenen, MI Schmalz, GK Johnson, DJ Geenen, WJ Hogan, and Midwest Pancreaticobiliary Group. St. Lukes Medical Center, Milwaukee, WI. Panereat~ is the most common major complication of diagnostic and therapeutic ERCT. Studies have reported the incidence of pancreatitis to be between 1-15% of all patient undergoing ERCP. The mechanism of injury during ERCP is unknown but likely includes chemical, thermal and mechanical factors. The rate of pancreatitis for specific therapeutic ERCP procedures has not been fully stratified. METHODS: The results of 2,954 patients undergoing ERCP for diagnostic 0,069) and therapeutic (1,885) were reviewed for cases of pancreatitis requiring hospitaliration. ~ t i c eases included sphincter of Oddi manometry (SOM) alone (315) or with sphincterotomy (176), sphineterotomy alone (571) or with stoat (225), stem alone (323), and others (266). Although other complications occurred including bleeding, perforation, and cholangitis; these were not considered in this study. Diagnosis of pancreatitis was defined as typical abdominal pain associated with elevation of amylase > 2 times normal values. RESULTS: Frequency of panereatitis in diagnostic cases was 4.7% compared to 10.9% in therapeutic eases. Rate of pancreatitis for specific therapeutic eases ranged from 6.0 to a high of 27.3%.