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Efficacy of the morphine-prostigmin test for evaluating patients with suspected papillary stenosis
Abstract:
The morphine-Prostigmin test (MPT) has been advocated as a diagnostic test for identifying patients with papillary stenosis. We studied 14 patients referred for possible papillary stenosis with the MPT and ERCP sphincter of Oddi manometry. The response to the MPT (symptoms, serum amylase/lipase values) was evaluated by multiple criteria. The MPT was also done on 6 volunteer control subjects. Operative evaluation of the sphincter of Oddi was obtained in 8 of the 14 patients. There was no correlation between the results of the MPT and ERCP manometry or operative findings. There was good correlation, however, between ERCP manometric findings and operative assessment of the sphincter of Oddi. Fifty percent of the volunteer subjects had a significantly positive enzyme response to the MPT. In our experience the MPT does not reliably detect patients with papillary stenosis.
Insights
The morphine-Prostigmin test (MPT) is not a reliable diagnostic tool for papillary stenosis. This study found no correlation between MPT results and other diagnostic methods for sphincter of Oddi dysfunction.
Area of Science:
- Gastroenterology
- Diagnostic testing
Background:
- Papillary stenosis, a condition affecting the sphincter of Oddi, can cause significant gastrointestinal issues.
- The morphine-Prostigmin test (MPT) has been proposed as a non-invasive method for diagnosing papillary stenosis.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the morphine-Prostigmin test (MPT) in patients with suspected papillary stenosis.
- To compare MPT results with endoscopic retrograde cholangiopancreatography (ERCP) sphincter of Oddi manometry and operative findings.
Main Methods:
- 14 patients with suspected papillary stenosis underwent both the MPT and ERCP sphincter of Oddi manometry.
- MPT responses (symptoms, enzyme levels) were assessed using multiple criteria.
- 8 patients had subsequent operative evaluation of the sphincter of Oddi.
- 6 healthy volunteers also underwent the MPT.
Main Results:
- No correlation was found between MPT results and ERCP manometry or operative findings.
- ERCP manometry showed good correlation with operative assessment of the sphincter of Oddi.
- 50% of healthy volunteers exhibited a positive enzyme response to the MPT, indicating a high false-positive rate.
Conclusions:
- The morphine-Prostigmin test (MPT) is not a reliable diagnostic test for papillary stenosis.
- ERCP sphincter of Oddi manometry is a more dependable method for assessing sphincter of Oddi function compared to MPT.