Reduced risk for pancreatitis after endoscopic microtransducer manometry of the sphincter of Oddi: a randomized comparison with the perfusion manometry technique.

BACKGROUND AND STUDY AIMS: Endoscopic microtransducer manometry of the sphincter of Oddi has been shown to be a reliable alternative to perfusion manometry for evaluating sphincter of Oddi motor function. It avoids volume loading of the biliopancreatic system, and may therefore be associated with a lower risk of inducing postmanometry pancreatitis.[nl] PATIENTS AND METHODS: During a 2-year period, microtransducer manometry of the sphincter of Oddi was carried out in 215 patients (median age 42 years; 155 women; biliary study in 152 cases, additional pancreatic evaluation in 63 cases). Sphincter of Oddi manometry was conducted as the sole procedure in all patients. The frequency of pancreatitis was assessed prospectively and graded according to established guidelines. A total of 130 consecutive patients (median age 37 years, 92 women; 30 with biliary type II, 58 with type III, 34 with pancreatic type I, and eight with type II) were then randomly assigned to undergo microtransducer or perfusion manometry of the sphincter of Oddi in a standardized fashion. RESULTS: During the initial 2-year period, nine cases of pancreatitis (a pancreatitis frequency of 4.2 %) were observed after microtransducer manometry, and most were of mild degree (six mild, two moderate, and one severe). No deaths occurred, and no surgical procedures were required. In the randomized part of the study, the demographic and clinical characteristics of the patients in both groups, as well as the technical aspects of the procedures performed, were well matched. The frequency of pancreatitis after microtransducer manometry was 3.1 %, compared with 13.8 % after perfusion manometry ( P < 0.05). Pancreatitis occurred in two patients after microtransducer manometry, and was mild in both cases. After perfusion manometry, mild pancreatitis occurred in six patients and moderate pancreatitis in three. CONCLUSION: Endoscopic microtransducer manometry of the sphincter of Oddi is associated with a lower risk for postmanometry pancreatitis than standard perfusion manometry.