1. Is endoscopic sphincterotomy avoidable in patients with sphincter of Oddi dysfunction?
- Author
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Ariadne Desjeux, Einate Abou-Berdugo, Rene Delpy, Véronique Vitton, Nathalie Lesavre, Marc Barthet, Jean-Charles Grimaud, Mohamed Gasmi, Centre de recherche en neurobiologie - neurophysiologie de Marseille (CRN2M), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Image et ville (IV), Université Louis Pasteur - Strasbourg I-Centre National de la Recherche Scientifique (CNRS), Physiopathologie du stress pancréatique, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche et d'Application en Traitement de l'Image et du Signal (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Université de Lyon-École Supérieure de Chimie Physique Électronique de Lyon (CPE)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Biomécanique Appliquée (LBA UMR T24), and Aix Marseille Université (AMU)-Université Gustave Eiffel
- Subjects
Male ,MESH: Cholecystectomy ,medicine.medical_treatment ,Gastroenterology ,0302 clinical medicine ,MESH: Sphincterotomy, Endoscopic ,MESH: Gastrointestinal Transit ,Prospective Studies ,Prospective cohort study ,MESH: Pain, Postoperative ,MESH: Treatment Outcome ,MESH: Aged ,Pain, Postoperative ,MESH: Middle Aged ,medicine.diagnostic_test ,MESH: Follow-Up Studies ,Middle Aged ,[SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biomolecules [q-bio.BM] ,3. Good health ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Acute pancreatitis ,Female ,030211 gastroenterology & hepatology ,Adult ,medicine.medical_specialty ,digestive system ,Sphincterotomy, Endoscopic ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Cholecystectomy ,[SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biochemistry [q-bio.BM] ,Gastrointestinal Transit ,Aged ,MESH: Humans ,Hepatology ,business.industry ,Gallbladder ,MESH: Adult ,medicine.disease ,MESH: Prospective Studies ,MESH: Male ,Endoscopy ,Surgery ,MESH: Sphincter of Oddi Dysfunction ,Sphincter of Oddi Dysfunction ,Sphincter of Oddi dysfunction ,Pancreatitis ,Sphincter ,business ,MESH: Female ,Follow-Up Studies - Abstract
International audience; AIM: Endoscopic sphincterotomy is an efficient means of treating sphincter of Oddi dysfunction (SOD), but it is associated with a morbidity rate of 20%. The aim of this study was to assess how frequently endoscopic sphincterotomy was performed to treat SOD in a group of patients with a 1-year history of medical management. METHODS: A total of 59 patients, who had been cholecystectomized 9.3 years previously on average, were included in this study and they all underwent biliary scintigraphy. Medical treatment was prescribed for 1 year. Endoscopic sphincterotomy was proposed for patients whose medical treatment had been unsuccessful. RESULTS: Eleven patients were rated group 1 on the Milwaukee classification scale, 34 group 2 and 14 group 3. The hile-duodenum transit time (HDTT) was lengthened in 32 patients. The medical treatment was efficient or fairly efficient in 45% of the group 1 patients, 67% of the group 2 patients, and 71.4% of the group 3 patients (P=0.29). Only 14 patients out of the 21 whose medical treatment was unsuccessful agreed to undergo endoscopic sphincterotomy. HDTT was lengthened in 11 of the 14 patients undergoing endoscopic sphincterotomy and in 21 of the 45 non-endoscopic sphincterotomy patients (P=0.03). Twelve of the 14 patients who underwent endoscopic sphincterotomy were cured. CONCLUSION: In this prospective series of patients with a 1-year history of medical management, only 23% of the patients with suspected SOD underwent endoscopic sphincterotomy although 54% had an abnormally long HDTT.
- Published
- 2008
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