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Pain on common bile duct injection during ERCP: does it indicate sphincter of Oddi dysfunction?
M J Schmalz1, J E Geenen, W J Hogan
1Division of Gastroenterology, Medical College of Wisconsin, Milwaukee.
Gastrointestinal Endoscopy
|September 1, 1990
Summary
Reproducing biliary pain during ERCP contrast injection is not a reliable indicator of sphincter of Oddi dysfunction. This study found no correlation between pain and manometric or imaging findings of dysfunction.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
Background:
- Biliary-type pain during ERCP contrast injection is a notable clinical observation.
- This phenomenon has been suggested as a potential diagnostic test for sphincter of Oddi dysfunction.
Purpose of the Study:
- To investigate the diagnostic value of pain reproduction upon contrast injection during ERCP for sphincter of Oddi dysfunction.
Main Methods:
- Sphincter of Oddi manometry was performed on 224 patients with suspected sphincter of Oddi dysfunction.
- Patients received intravenous diazepam as premedication for ERCP.
- Pain reproduction, delayed drainage, bile duct dilation, and basal sphincter of Oddi pressure were assessed.
Main Results:
- Pain was reproduced in 6.7% of patients immediately after contrast injection.
- No significant correlation was found between pain reproduction and elevated basal sphincter of Oddi pressure, delayed drainage, or bile duct dilation.
- Abnormal liver enzymes also did not correlate with pain on contrast injection.
Conclusions:
- Reproduction of biliary pain during ERCP contrast injection is not a reliable provocative test for diagnosing sphincter of Oddi dysfunction.
- Clinical and manometric parameters did not support pain on injection as an indicator of sphincter of Oddi dysfunction.