Sphincter of Oddi dysfunction (SOD) is a term used to describe a group of heterogenous pain syndromes caused by abnormalities in sphincter contractility. Biliary and pancreatic SOD are each sub-classified as typeⅠ,Ⅱ...Sphincter of Oddi dysfunction (SOD) is a term used to describe a group of heterogenous pain syndromes caused by abnormalities in sphincter contractility. Biliary and pancreatic SOD are each sub-classified as typeⅠ,Ⅱ or Ⅲ,according to the Milwaukee classification. SOD appears to carry an increased risk of acute pancreatitis as well as rates of post ERCP pancreatitis of over 30%. Various mechanisms have been postulated but the exact role of SOD in the pathophysiology of acute pancreatitis is unknown. There is also an association between SOD and chronic pancreatitis but it is still unclear if this is a cause or effect relationship. Management of SOD is aimed at sphincter ablation,usually by endoscopic sphincterotomy (ES). Patients with typeⅠSOD will benefit from ES in 55%-95% of cases. Sphincter of Oddi manometry is not necessary before ES in typeⅠ SOD. For patients with types Ⅱ and Ⅲ the benefit of ES is lower. These patients should be more thoroughly evaluated before performing ES. Some researchers have found that manometry and ablation of both the biliary and pancreatic sphincters is required to adequately assess and treat SOD. In pancreatic SOD up to 88% of patients will benefit from sphincterotomy. Therefore,there have been calls from some quarters for the current classification system to be scrapped in favour of an overall system encompassing both biliary and pancreatic types. Future work should be aimed at understanding the mechanisms underlying the relationship between SOD and pancreatitis and identifying patient factors that will help predict benefit from endoscopic therapy.展开更多
Although there are numerous causes of acute panc-reatitis, an etiology cannot always be found. Two potential etiologies, microlithiasis and sphincter of Oddi dysfunction, are discussed in this review. Gallbladder micr...Although there are numerous causes of acute panc-reatitis, an etiology cannot always be found. Two potential etiologies, microlithiasis and sphincter of Oddi dysfunction, are discussed in this review. Gallbladder microlithiasis, missed on transcutaneous ultrasound, is reported as the cause of idiopathic acute pancreatitis in a wide frequency range of 6%-80%. The best diagnostic technique for gallbladder microlithiasis is endoscopic ultrasound although biliary crystal analysis and empiric cholecystectomy remain as reasonable options. In contrast, in patients who are post-cholecystectomy, bile duct microlithiasis does not appear to have a role in the pathogenesis of acute pancreatitis. Sphincter of Oddi dysfunction is present in 30%-65% of patients with idiopathic acute recurrent pancreatitis in whom other diagnoses have been excluded. It is unclear if this sphincter dysfunction was the original etiology of the first episode of pancreatitis although it appears to have a causative role in recurring episodes since sphincter ablation decreases the frequency of recurrent attacks. Unfortunately, this conclusion is primarily based on small retrospective case series; larger prospective studies of the outcome of pancreatic sphincterotomy for SOD-associated acute pancreatitis are sorely needed. Another problem with this diagnosis and its treatment is the concern over potential procedure related complications from endoscopic retrograde cholangiopancreatography (ERCP), manometry and pancreatic sphincterotomy. For these reasons, patients should have recurrent acute pancreatitis, not a single episode, and have a careful informed consent before assessment of the sphincter of Oddi is undertaken.展开更多
The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis.We searched for and evaluated all articles describing the diagnosis,epidemiology,pat...The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis.We searched for and evaluated all articles describing the diagnosis,epidemiology,pathophysiology,morbidity,mortality and prevention of post-ERCP pancreatitis(PEP) in adult patients using the PubMed database.Search terms included endoscopic retrograde cholangiopancreatography,pancreatitis,ampulla of vater,endoscopic sphincterotomy,balloon dilatation,cholangiography,adverse events,standards and utilization.We limited our review of articles to those published between January 1,1994 and August 15,2009 regarding human adults and written in the English language.Publicat ions from the reference sections were reviewed and included if they were salient and fell into the time period of interest.Between the dates queried,seventeen large(> 500 patients) prospective and four large retrospective trials were conducted.PEP occurred in 1-15 in the prospective trials and in 1-4 in the retrospective trials.PEP was also reduced with pancreatic duct stent placement and outcomes were improved with endoscopic sphincterotomy compared to balloon sphincter dilation in the setting of choledocholithiasis.Approximately 34 pharmacologic agents have been evaluated for the prevention of PEP over the last f ifteen years in 63 trials.Although 22 of 63 trials published during our period of review suggested a reduction in PEP,no pharmacologic therapy has been widely accepted in clinical use in decreasing the development of PEP.In conclusion,PEP is a well-recognized complication of ERCP.Medical treatment for prevention has been disappointing.Proper patient selection and pancreatic duct stenting have been shown to reduce the complication rate in randomized clinical trials.展开更多
Acute recurrent pancreatitis is a clinical entity largely associated with pancreatic ductal obstruction. This latter includes congenital variants, of which pancreas divisum is the most frequent but also controversial,...Acute recurrent pancreatitis is a clinical entity largely associated with pancreatic ductal obstruction. This latter includes congenital variants, of which pancreas divisum is the most frequent but also controversial, chronic pancreatitis, tumors of the pancreaticobiliary junction and sphincter of Oddi dysfunction. This review summarizes current knowledge about diagnostic work-up and therapy of these conditions.展开更多
Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a largely diagnostic to a largely therapeutic modality. Cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging (...Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a largely diagnostic to a largely therapeutic modality. Cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), and less invasive endoscopy, especially endoscopic ultrasound (EUS), have largely taken over from ERCP for diagnosis. However, ERCP remains the "first line" therapeutic tool in the management of mechanical causes of acute recurrent pancreatitis, including bile duct stones (choledocholithiasis), ampullary masses (benign and malignant), congenital variants of biliary and pancreatic anatomy (e.g. pancreas divisum, choledochoceles), sphincter of Oddi dysfunction (SOD), pancreatic stones and strictures, and parasitic disorders involving the biliary tree and/or pancreatic duct (e.g Ascariasis, Clonorchiasis).展开更多
Recent advances in understanding of pancreatitis and advances in technology have uncovered the veils of idiopathic pancreatitis to a point where a thorough history and judicious use of diagnostic techniques elucidate ...Recent advances in understanding of pancreatitis and advances in technology have uncovered the veils of idiopathic pancreatitis to a point where a thorough history and judicious use of diagnostic techniques elucidate the cause in over 80% of cases. This review examines the multitude of etiologies of what were once labeled idiopathic pancreatitis and provides the current evidence on each. This review begins with a background review of the current epidemiology of idiopathic pancreatitis prior to discussion of various etiologies. Etiologies of medications,infections,toxins,autoimmune disorders,vascular causes,and anatomic and functional causes are explored in detail. We conclude with management of true idiopathic pancreatitis and a summary of the various etiologic agents. Throughout this review,areas of controversies are highlighted.展开更多
An accurate, noninvasive and cost-effective method of in situ tissue evaluation during endoscopy would be highly advantageous for the detection of dysplasia or early cancer and for identifying different disease stages...An accurate, noninvasive and cost-effective method of in situ tissue evaluation during endoscopy would be highly advantageous for the detection of dysplasia or early cancer and for identifying different disease stages. Optical coherence tomography(OCT) is a noninvasive, high-resolution(1-10 μm) emerging optical imaging method with potential for identifying microscopic subsurface features in the pancreatic and biliary ductal system. Tissue microstructure of pancreaticobiliary ductal system has been successfully imaged by inserting an OCT probe through a standard endoscope operative channel. High-resolution OCT images and the technique's endoscopic compatibility have allowed for the microstructural diagnostic of thepancreatobiliary diseases. In this review, we discussed currently available pancreaticobiliary ductal imaging systems to assess the pancreatobiliary tissue microstructure and to evaluate varieties of pancreaticobiliary disorders and diseases. Results show that OCT can improve the quality of images of pancreatobiliary system during endoscopic retrograde cholangiopancheatography procedure, which may be important in distinguishing between the neoplastic and non-neoplastic lesions.展开更多
内镜下Oddi括约肌测压可直接对Oddi括约肌(sphincter of oddi,SO)运动功能进行评价,被认为是Oddi括约肌功能障碍(sphincter of oddi dysfunction,SOD)诊断的金标准,对Oddi括约肌功能障碍的治疗及预后判断具有很大意义。Oddi括约肌测压(S...内镜下Oddi括约肌测压可直接对Oddi括约肌(sphincter of oddi,SO)运动功能进行评价,被认为是Oddi括约肌功能障碍(sphincter of oddi dysfunction,SOD)诊断的金标准,对Oddi括约肌功能障碍的治疗及预后判断具有很大意义。Oddi括约肌测压(Sphincter of oddi manometry,SOM)是一项有创性的操作,对操作人员要求严格,术后胰腺炎发生风险高,临床应用受到一定限制。目前一些研究主要致力于通过改善导管构造、类型,明确SOM适应证,谨慎选择患者来减少SOM术后相关胰腺炎的发生率。本文就Oddi括约肌测压的技术方法,有效性、安全性、数据结果的准确性、测压术后合并症,以及其在胆胰疾病诊治中的应用作一综述。展开更多
AIM: To analyze the indications, effi cacy and safety of sphincteroplasty in our centre. METHODS: A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure...AIM: To analyze the indications, effi cacy and safety of sphincteroplasty in our centre. METHODS: A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the fi lling pressure. RESULTS: The indications included intradiverticular papilla in 26 patients (49/), stenosis of a previous sphincterotomy in 19 patients (35.8/), small size of the papilla in 4 patients (7.5/), Billroth Ⅱ gastrectomy in 3 patients (5.6/), and coagulopathy in one patient (1.9/). The efficacy was 97.8/, with all the calculi extracted from the common bile duct in 84.4/ of the patients, even though 21 of the patients (39.6/) had calculi with a diameter equal to or greater than 10 mm. Seven patients (13.2/) presented complications: haemorrhage in 1 patient (1.9/) and mild pancreatitis in 6 patients (11.3/). The mean hospital stay in case of complications was of 3 ± 0.63 d. CONCLUSION: Sphincteroplasty is highly effective, with a complication rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort tolithotripsy or rescue sphincterotomy.展开更多
Considerable controversy surrounds the adoption ofendoscopic sphincterotomy (ES) to facilitate the placementof 10F plastic stents (PS) and to reduce the risk of pancreatitisThe aim of the study was to assess the possi...Considerable controversy surrounds the adoption ofendoscopic sphincterotomy (ES) to facilitate the placementof 10F plastic stents (PS) and to reduce the risk of pancreatitisThe aim of the study was to assess the possible advantagesof ES before PS placement.展开更多
文摘Sphincter of Oddi dysfunction (SOD) is a term used to describe a group of heterogenous pain syndromes caused by abnormalities in sphincter contractility. Biliary and pancreatic SOD are each sub-classified as typeⅠ,Ⅱ or Ⅲ,according to the Milwaukee classification. SOD appears to carry an increased risk of acute pancreatitis as well as rates of post ERCP pancreatitis of over 30%. Various mechanisms have been postulated but the exact role of SOD in the pathophysiology of acute pancreatitis is unknown. There is also an association between SOD and chronic pancreatitis but it is still unclear if this is a cause or effect relationship. Management of SOD is aimed at sphincter ablation,usually by endoscopic sphincterotomy (ES). Patients with typeⅠSOD will benefit from ES in 55%-95% of cases. Sphincter of Oddi manometry is not necessary before ES in typeⅠ SOD. For patients with types Ⅱ and Ⅲ the benefit of ES is lower. These patients should be more thoroughly evaluated before performing ES. Some researchers have found that manometry and ablation of both the biliary and pancreatic sphincters is required to adequately assess and treat SOD. In pancreatic SOD up to 88% of patients will benefit from sphincterotomy. Therefore,there have been calls from some quarters for the current classification system to be scrapped in favour of an overall system encompassing both biliary and pancreatic types. Future work should be aimed at understanding the mechanisms underlying the relationship between SOD and pancreatitis and identifying patient factors that will help predict benefit from endoscopic therapy.
文摘Although there are numerous causes of acute panc-reatitis, an etiology cannot always be found. Two potential etiologies, microlithiasis and sphincter of Oddi dysfunction, are discussed in this review. Gallbladder microlithiasis, missed on transcutaneous ultrasound, is reported as the cause of idiopathic acute pancreatitis in a wide frequency range of 6%-80%. The best diagnostic technique for gallbladder microlithiasis is endoscopic ultrasound although biliary crystal analysis and empiric cholecystectomy remain as reasonable options. In contrast, in patients who are post-cholecystectomy, bile duct microlithiasis does not appear to have a role in the pathogenesis of acute pancreatitis. Sphincter of Oddi dysfunction is present in 30%-65% of patients with idiopathic acute recurrent pancreatitis in whom other diagnoses have been excluded. It is unclear if this sphincter dysfunction was the original etiology of the first episode of pancreatitis although it appears to have a causative role in recurring episodes since sphincter ablation decreases the frequency of recurrent attacks. Unfortunately, this conclusion is primarily based on small retrospective case series; larger prospective studies of the outcome of pancreatic sphincterotomy for SOD-associated acute pancreatitis are sorely needed. Another problem with this diagnosis and its treatment is the concern over potential procedure related complications from endoscopic retrograde cholangiopancreatography (ERCP), manometry and pancreatic sphincterotomy. For these reasons, patients should have recurrent acute pancreatitis, not a single episode, and have a careful informed consent before assessment of the sphincter of Oddi is undertaken.
文摘The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis.We searched for and evaluated all articles describing the diagnosis,epidemiology,pathophysiology,morbidity,mortality and prevention of post-ERCP pancreatitis(PEP) in adult patients using the PubMed database.Search terms included endoscopic retrograde cholangiopancreatography,pancreatitis,ampulla of vater,endoscopic sphincterotomy,balloon dilatation,cholangiography,adverse events,standards and utilization.We limited our review of articles to those published between January 1,1994 and August 15,2009 regarding human adults and written in the English language.Publicat ions from the reference sections were reviewed and included if they were salient and fell into the time period of interest.Between the dates queried,seventeen large(> 500 patients) prospective and four large retrospective trials were conducted.PEP occurred in 1-15 in the prospective trials and in 1-4 in the retrospective trials.PEP was also reduced with pancreatic duct stent placement and outcomes were improved with endoscopic sphincterotomy compared to balloon sphincter dilation in the setting of choledocholithiasis.Approximately 34 pharmacologic agents have been evaluated for the prevention of PEP over the last f ifteen years in 63 trials.Although 22 of 63 trials published during our period of review suggested a reduction in PEP,no pharmacologic therapy has been widely accepted in clinical use in decreasing the development of PEP.In conclusion,PEP is a well-recognized complication of ERCP.Medical treatment for prevention has been disappointing.Proper patient selection and pancreatic duct stenting have been shown to reduce the complication rate in randomized clinical trials.
文摘Acute recurrent pancreatitis is a clinical entity largely associated with pancreatic ductal obstruction. This latter includes congenital variants, of which pancreas divisum is the most frequent but also controversial, chronic pancreatitis, tumors of the pancreaticobiliary junction and sphincter of Oddi dysfunction. This review summarizes current knowledge about diagnostic work-up and therapy of these conditions.
文摘Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a largely diagnostic to a largely therapeutic modality. Cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), and less invasive endoscopy, especially endoscopic ultrasound (EUS), have largely taken over from ERCP for diagnosis. However, ERCP remains the "first line" therapeutic tool in the management of mechanical causes of acute recurrent pancreatitis, including bile duct stones (choledocholithiasis), ampullary masses (benign and malignant), congenital variants of biliary and pancreatic anatomy (e.g. pancreas divisum, choledochoceles), sphincter of Oddi dysfunction (SOD), pancreatic stones and strictures, and parasitic disorders involving the biliary tree and/or pancreatic duct (e.g Ascariasis, Clonorchiasis).
文摘Recent advances in understanding of pancreatitis and advances in technology have uncovered the veils of idiopathic pancreatitis to a point where a thorough history and judicious use of diagnostic techniques elucidate the cause in over 80% of cases. This review examines the multitude of etiologies of what were once labeled idiopathic pancreatitis and provides the current evidence on each. This review begins with a background review of the current epidemiology of idiopathic pancreatitis prior to discussion of various etiologies. Etiologies of medications,infections,toxins,autoimmune disorders,vascular causes,and anatomic and functional causes are explored in detail. We conclude with management of true idiopathic pancreatitis and a summary of the various etiologic agents. Throughout this review,areas of controversies are highlighted.
文摘An accurate, noninvasive and cost-effective method of in situ tissue evaluation during endoscopy would be highly advantageous for the detection of dysplasia or early cancer and for identifying different disease stages. Optical coherence tomography(OCT) is a noninvasive, high-resolution(1-10 μm) emerging optical imaging method with potential for identifying microscopic subsurface features in the pancreatic and biliary ductal system. Tissue microstructure of pancreaticobiliary ductal system has been successfully imaged by inserting an OCT probe through a standard endoscope operative channel. High-resolution OCT images and the technique's endoscopic compatibility have allowed for the microstructural diagnostic of thepancreatobiliary diseases. In this review, we discussed currently available pancreaticobiliary ductal imaging systems to assess the pancreatobiliary tissue microstructure and to evaluate varieties of pancreaticobiliary disorders and diseases. Results show that OCT can improve the quality of images of pancreatobiliary system during endoscopic retrograde cholangiopancheatography procedure, which may be important in distinguishing between the neoplastic and non-neoplastic lesions.
文摘内镜下Oddi括约肌测压可直接对Oddi括约肌(sphincter of oddi,SO)运动功能进行评价,被认为是Oddi括约肌功能障碍(sphincter of oddi dysfunction,SOD)诊断的金标准,对Oddi括约肌功能障碍的治疗及预后判断具有很大意义。Oddi括约肌测压(Sphincter of oddi manometry,SOM)是一项有创性的操作,对操作人员要求严格,术后胰腺炎发生风险高,临床应用受到一定限制。目前一些研究主要致力于通过改善导管构造、类型,明确SOM适应证,谨慎选择患者来减少SOM术后相关胰腺炎的发生率。本文就Oddi括约肌测压的技术方法,有效性、安全性、数据结果的准确性、测压术后合并症,以及其在胆胰疾病诊治中的应用作一综述。
文摘AIM: To analyze the indications, effi cacy and safety of sphincteroplasty in our centre. METHODS: A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the fi lling pressure. RESULTS: The indications included intradiverticular papilla in 26 patients (49/), stenosis of a previous sphincterotomy in 19 patients (35.8/), small size of the papilla in 4 patients (7.5/), Billroth Ⅱ gastrectomy in 3 patients (5.6/), and coagulopathy in one patient (1.9/). The efficacy was 97.8/, with all the calculi extracted from the common bile duct in 84.4/ of the patients, even though 21 of the patients (39.6/) had calculi with a diameter equal to or greater than 10 mm. Seven patients (13.2/) presented complications: haemorrhage in 1 patient (1.9/) and mild pancreatitis in 6 patients (11.3/). The mean hospital stay in case of complications was of 3 ± 0.63 d. CONCLUSION: Sphincteroplasty is highly effective, with a complication rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort tolithotripsy or rescue sphincterotomy.
文摘Considerable controversy surrounds the adoption ofendoscopic sphincterotomy (ES) to facilitate the placementof 10F plastic stents (PS) and to reduce the risk of pancreatitisThe aim of the study was to assess the possible advantagesof ES before PS placement.
