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. 1988 Jul;70(4):205–211.

Pancreatic sphincteroplasty: indications and outcome.

R C Williamson 1
PMCID: PMC2498807  PMID: 3415169

Abstract

Twenty patients received transduodenal pancreatic sphincteroplasty for one of three indications: post-cholecystectomy pain with a strongly positive Nardi test (n = 5), recurrent attacks of idiopathic acute pancreatitis (n = 7) and chronic pancreatitis (n = 8). Three patients had an accessory sphincteroplasty in addition to double sphincteroplasty at the major papilla (transampullary septectomy). Pain was relieved in four of the five post-cholecystectomy patients at a median 21 months after sphincteroplasty. On a scale from 0-10 the mean pain score decreased from 9.1 to 2.8, and the preoperative rise in serum amylase with morphine-prostigmine provocation was abolished. None of the patients with recurrent pancreatitis has had a further attack postoperatively, though one had transient pain without hyperamylasaemia. Performed as an adjunct to other pancreatobiliary procedures in five cases, sphincteroplasty has contributed to a satisfactory result in all but two of those with chronic pancreatitis. The only serious complication was an infected pancreatic collection in two patients with concomitant resection or drainage of the distal pancreas.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Blair A. J., 3rd, Russell C. G., Cotton P. B. Resection for pancreatitis in patients with pancreas divisum. Ann Surg. 1984 Nov;200(5):590–594. doi: 10.1097/00000658-198411000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cooper M. J., Williamson R. C. The value of operative pancreatography. Br J Surg. 1983 Oct;70(10):577–580. doi: 10.1002/bjs.1800701003. [DOI] [PubMed] [Google Scholar]
  3. Cooperman M., Ferrara J. J., Carey L. C., Thomas F. B., Martin E. W., Jr, Fromkes J. J. Idiopathic acute pancreatitis: the value of endoscopic retrograde cholangiopancreatography. Surgery. 1981 Oct;90(4):666–670. [PubMed] [Google Scholar]
  4. Corfield A. P., Cooper M. J., Williamson R. C. Acute pancreatitis: a lethal disease of increasing incidence. Gut. 1985 Jul;26(7):724–729. doi: 10.1136/gut.26.7.724. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. DOUBILET H., MULHOLLAND J. H. Eight-year study of pancreatitis and sphincterotomy. J Am Med Assoc. 1956 Feb 18;160(7):521–528. doi: 10.1001/jama.1956.02960420001001. [DOI] [PubMed] [Google Scholar]
  6. Gregg J. A., Monaco A. P., McDermott W. V. Pancreas divisum. Results of surgical intervention. Am J Surg. 1983 Apr;145(4):488–492. doi: 10.1016/0002-9610(83)90045-4. [DOI] [PubMed] [Google Scholar]
  7. Gregg J. A., Taddeo A. E., Milano A. F., McCartney A. J., Santoro B. T., Frager S. H., Capobianco A. G. Duodenoscopy and endoscopic pancreatography in patients with postive morphine prostigmine tests. Am J Surg. 1977 Sep;134(3):318–321. doi: 10.1016/0002-9610(77)90396-8. [DOI] [PubMed] [Google Scholar]
  8. LoGiudice J. A., Geenen J. E., Hogan W. J., Dodds W. J. Efficacy of the morphine-prostigmin test for evaluating patients with suspected papillary stenosis. Dig Dis Sci. 1979 Jun;24(6):455–458. doi: 10.1007/BF01299827. [DOI] [PubMed] [Google Scholar]
  9. Madura J. A., McCammon R. L., Paris J. M., Jesseph J. E. The Nardi test and biliary manometry in the diagnosis of pancreaticobiliary sphincter dysfunction. Surgery. 1981 Oct;90(4):588–595. [PubMed] [Google Scholar]
  10. Moody F. G., Becker J. M., Potts J. R. Transduodenal sphincteroplasty and transampullary septectomy for postcholecystectomy pain. Ann Surg. 1983 May;197(5):627–636. doi: 10.1097/00000658-198305000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Nardi G. L., Michelassi F., Zannini P. Transduodenal sphincteroplasty. 5-25 year follow-up of 89 patients. Ann Surg. 1983 Oct;198(4):453–461. doi: 10.1097/00000658-198310000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Partington P. F. Twenty-three years of experience with sphincterotomy and sphincteroplasty for stenosis of the sphincter of Oddi. Surg Gynecol Obstet. 1977 Aug;145(2):161–168. [PubMed] [Google Scholar]
  13. Roberts-Thomson I. C., Toouli J. Abnormal responses to morphine-neostigmine in patients with undefined biliary type pain. Gut. 1985 Dec;26(12):1367–1372. doi: 10.1136/gut.26.12.1367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Roberts-Thomson I. C., Toouli J. Is endoscopic sphincterotomy for disabling biliary-type pain after cholecystectomy effective? Gastrointest Endosc. 1985 Dec;31(6):370–373. doi: 10.1016/s0016-5107(85)72250-x. [DOI] [PubMed] [Google Scholar]
  15. Steinberg W. M., Salvato R. F., Toskes P. P. The morphine-prostigmin provocative test--is it useful for making clinical decisions? Gastroenterology. 1980 Apr;78(4):728–731. [PubMed] [Google Scholar]
  16. Tanaka M., Ikeda S., Matsumoto S., Yoshimoto H., Nakayama F. Manometric diagnosis of sphincter of Oddi spasm as a cause of postcholecystectomy pain and the treatment by endoscopic sphincterotomy. Ann Surg. 1985 Dec;202(6):712–719. doi: 10.1097/00000658-198512000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Taylor E. W., Bentley S., Youngs D., Keighley M. R. Bowel preparation and the safety of colonoscopic polypectomy. Gastroenterology. 1981 Jul;81(1):1–4. [PubMed] [Google Scholar]
  18. Thompson M. H., Williamson R. C., Salmon P. R. The clinical relevance of isolated ventral pancreas. Br J Surg. 1981 Feb;68(2):101–104. doi: 10.1002/bjs.1800680212. [DOI] [PubMed] [Google Scholar]
  19. Toouli J., Roberts-Thomson I. C., Dent J., Lee J. Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis. Br J Surg. 1985 Nov;72(11):859–863. doi: 10.1002/bjs.1800721104. [DOI] [PubMed] [Google Scholar]
  20. Warshaw A. L., Richter J. M., Schapiro R. H. The cause and treatment of pancreatitis associated with pancreas divisum. Ann Surg. 1983 Oct;198(4):443–452. doi: 10.1097/00000658-198310000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Warshaw A. L., Simeone J., Schapiro R. H., Hedberg S. E., Mueller P. E., Ferrucci J. T., Jr Objective evaluation of ampullary stenosis with ultrasonography and pancreatic stimulation. Am J Surg. 1985 Jan;149(1):65–72. doi: 10.1016/s0002-9610(85)80011-8. [DOI] [PubMed] [Google Scholar]

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