Sphincterotomy for biliary sphincter of Oddi disorder and idiopathic acute recurrent pancreatitis: the RESPOnD longitudinal cohort.

Autor:	Coté GA; Department of Medicine, Division of Gastroenterology & Hepatology, Oregon Health & Science University, Portland, Oregon, USA coteg@ohsu.edu., Elmunzer BJ; Gastroenterology, Medical University of South Carolina, Charleston, South Carolina, USA., Nitchie H; Department of Medicine, Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA., Kwon RS; Medicine/Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA., Willingham F; Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA., Wani S; School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA., Kushnir V; Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA., Chak A; Division of Gastroenterology and Liver Disease, University Hospitals Case Medical Center, Cleveland, Ohio, USA., Singh V; Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA., Papachristou GI; Department of Medicine, Division of Gastroenterology & Hepatology, The Ohio State University, Columbus, Ohio, USA., Slivka A; Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Freeman M; University of Minnessota, Minneapolis, Minnesota, USA., Gaddam S; Cedars-Sinai Medical Center, Los Angeles, California, USA., Jamidar P; Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA., Tarnasky P; Methodist Digestive Institute, Dallas, Texas, USA., Varadarajulu S; Digestive Health Institute, Orlando, Florida, USA., Foster LD; Department of Public Health Science, Medical University of South Carolina, Charleston, South Carolina, USA., Cotton P; Medicine, DDC, Medical University of South Carolina, Charleston, South Carolina, USA.
Jazyk:	angličtina
Zdroj:	Gut [Gut] 2024 Sep 07. Date of Electronic Publication: 2024 Sep 07.
DOI:	10.1136/gutjnl-2024-332686
Abstrakt:	Objective: Sphincter of Oddi disorders (SOD) are contentious conditions in patients whose abdominal pain, idiopathic acute pancreatitis (iAP) might arise from pressurisation at the sphincter of Oddi. The present study aimed to measure the benefit of sphincterotomy for suspected SOD. Design: Prospective cohort conducted at 14 US centres with 12 months follow-up. Patients undergoing first-time endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy for suspected SOD were eligible: pancreatobiliary-type pain with or without iAP. The primary outcome was defined as the composite of improvement by Patient Global Impression of Change (PGIC), no new or increased opioids and no repeat intervention. Missing data were addressed by hierarchal, multiple imputation scheme. Results: Of 316 screened, 213 were enrolled with 190 (89.2%) of these having a dilated bile duct, abnormal labs, iAP or some combination. By imputation, an average of 122/213 (57.4% (95% CI 50.4% to 64.4%)) improved; response rate was similar for those with complete follow-up (99/161, 61.5% (54.0% to 69.0%)); of these, 118 (73.3%) improved by PGIC alone. Duct size, elevated labs and patient characteristics were not associated with response. AP occurred in 37/213 (17.4%) at a median of 6 months post ERCP and was more likely in those with a history of AP (30.9% vs 2.9%, p<0.0001). Conclusion: Nearly 60% of patients undergoing ERCP for suspected SOD improve, although the contribution of a placebo response is unknown. Contrary to prevailing belief, duct size and labs are poor response predictors. AP recurrence was common and like observations from prior non-intervention cohorts, suggesting no benefit of sphincterotomy in mitigating future AP episodes. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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