SPHINCTER OF ODDI DYSFUNCTION ERCP ENDOSCOPIC THERAPY CHRISTOS KARALIS, MD. скачать в хорошем качестве

SPHINCTER OF ODDI DYSFUNCTION ERCP ENDOSCOPIC THERAPY CHRISTOS KARALIS, MD.

Biliary SOD has been classified into three modern categories, Type I, II, and III. Type I has typical pain, elevated liver enzymes and dilated bile ducts, type II has pain plus one of the other criteria, and type III has typical biliary pain only. Type I patients have a 90% response rate to biliary sphincterotomy and a false normal sphincter manometry in 14-35% which has led to the conclusion that these patients should simply undergo ES without manometry. In practice, type II pts, particularly those with enzyme elevation associated with episodic pain attacks frequently also undergo empiric sphincterotomy although 2 randomized trials have shown that SOM results in this group is predictive of clinical response. Type III patients are a controversial group and must be studied with manometry before undertaking the risk of biliary ES. It is clear that SOD patients are at high risk for post-ERCP pancreatitis and should receive a prophylactic temporary pancreatic duct stent and rectal indomethacin to lower their risk. This patient had type I SOD with elevated biliary enzymes and amylase during attacks and received dual sphincterotomy with prophylactic pancreatic duct stent placement and rectal indomethasid suppository for post ERCP pancreatitis prophylaxis. Prior to ERCP an endoscopic ultrasound was performed to exclude CBD stones as a cause of her symptoms which was negative.