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Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry without endoscopic retrograde cholangiopancreatography
S82
Abstracts
cells). while the chronic inflammatory response dominated in each case, a significant minority of PMN cells was always present. Amylase and lipase levels were similar in group A and B. Conclusions: Intraductal infusion of Gabexate Mesylate doesn’t produce any significant ductal, vascular or acinar injury. However, GM was not effective in preventing pancreatitis induction by ERCP in our dog model. We believe that the efficacy of intraductal GM should be tested in large controlled trials in human. 257 Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry without endoscopic retrograde cholangiopancreatography Syed T. Bin-Sagheer, M.D., Patrick G. Brady, M.D., Jay J. Mamel, M.D., Bruce Robinson, M.D., Division of Digestive Diseases, University of South Florida, Tampa, Florida. Purpose: Acute pancreatitis is a recognized complication of sphincter of Oddi manometry (SOM). Its frequency of occurrence has been reported in the range of 4% to 31%. In an earlier retrospective study done at this institution the incidence of pancreatitis was 9.3% in patients who only had SOM when compared to 26.1% in those patients who had SOM and ERCP with or without sphincterotomy at the same session. Looking at this data as a measure of quality improvement, at two university-affiliated hospitals, SOM was done without ERCP and if ERCP was required it was done at a different session. The purpose was to see if this practice decreases the incidence of pancreatitis. Methods: A prospective patient identification, retrospective chart review, of patients who underwent SOM without ERCP between May 98 and December 2000 was performed. SOM was performed using a triple lumen catheter with water perfusion at a rate of 0.25 ml/min using an Arndorfer pneumohydraulic capillary perfusion system. The data recorded included pancreatitis after SOM, pancreatitis after ERCP and sphincterotomy, average days in the hospital after pancreatitis and time between SOM and ERCP. Results: A total of 41 patients were studied. Three (7.32%) patients had pancreatitis after SOM. Five patients subsequently underwent ERCP and sphincterotomy and one (20%) patient had pancreatitis. The overall frequency of pancreatitis after SOM and any subsequent ERCP or sphincterotomy was 4/41 (9.78%). The average days in the hospital after pancreatitis ranged from 2– 4 days, mean 2.75 days. The time between SOM and ERCP if done ranged from 6 –20 days, mean 10.4 days. Conclusions: By adopting a protocol to perform SOM only and following with ERCP when required, we were able to decrease the incidence of pancreatitis considerably at our institutions. 258 Complete Choledocal Sphincterotomy (CCS) is effective in the treatment of recurrent pain post biliary sphincterotomy Rodrigo A Castillo, MD1, Manish Dhawan, MD1, Rad Agrawal, MD FACG 1 and TJ Ravi, MD 1*. 1Gastroenterology, Allegheny, General, Hospital, United States. Purpose: To recognize intestinal pseudo-obstruction secondary to Myotonic Muscular Dystrophy. Case presentation: A 24-year old white male with past medical history significant for asthma was admitted for a fourth episode of intestinal obstruction within the last 5 years. The first two episodes resolved with medical therapy. The third episode, 2 years ago, resulted in an exploratory laparotomy without any surgical pathology. His family history was significant for myotonic muscular dystrophy in his maternal grandmother and mother. The physical examination revealed bilateral temporal wasting, ptosis, atrophy of the sternocleidomastoid muscles and distal extremity weakness. Myotonia was noted in his hands. Abdomen was soft and scaphoid with diffuse tenderness.
AJG – Vol. 96, No. 9, Suppl., 2001
Laboratory data revealed contraction metabolic alkalosis, respiratory acidosis, hyperkalemia, hypocalcemia and acute renal failure. CPK, aldolase, FSH were elevated at 1196U/L (55-170U/L), 11.6U/L (0.4U/L), and 16.2MIU/ML (1-12MIU/L) respectively. Free and total testosterone levels were decreased at 2.6ng/dL (9-30ng/dL) and 60ng/dL (300-950ng/dL) respectively. DNA analysis showed 552 CTG trinucleotide repeats on the MPK gene consistent with full mutation for myotonic dystrophy. TSH, C-reactive protein, CBC and LFTs were within the normal range. EKG showed sinus tachycardia with mild intraventricular delay in leads II, III and aVF (QRS duration: 104ms). Patient had persistent obstructive picture. An abdominal CT showed extensive dilation of small bowel loops with a cut-off point at the distal small bowel. Exploratory laparotomy revealed adhesions and a thick fibrous band. They were lysed. Post-operatively, he continued to have high NG output for a prolonged period of time. Repeated plain X-rays of the abdomen and SBFT demonstrated persistent dilation of small bowel loops. No mechanical obstruction or mucosal abnormalities were identified. Patient eventually improved on IV prokinetic agents (metoclopramide and erythromycin). He was discharged on oral metoclopramide. Conclusions: Myotonic muscular dystrophy should be considered as a possible etiology of recurrent intestinal pseudo-obstruction. It is a rare autosomal dominant disorder which is always transmitted from the affected mother to her offspring. The condition is a product of an unstable CTG trinucleotide repeat in the MKP gene on chromosome 19q13.3. It affects all types of muscle. Most patients die between the ages of 40 and 60 years from cardiac and pulmonary complications. Treatment is symptomatic.
259 Outcomes of endoscopic management of post liver transplant biliary strictures Andrew T Catanzaro MD1, Gerard A Isenberg MD1*, Robert O’Shea MD1, Amitabh Chak MD1, Anthony Post MD1 and Michael V Sivak Jr. MD1. 1Division of Gastroenterology, University Hospitals of Cleveland Case Western Reserve University School of Medicine, Cleveland, Ohio, United States. Purpose: To evaluate the outcome of patients (pts) receiving endoscopic treatment for post liver transplant (OLT) biliary strictures (BS) at our institution. Methods: From 1989 to 2000, 296 pts had an OLT. Pts who had a choledocho-choledochostomy anastomosis and BS treated endoscopically were identified. Pts received a combination of dilation with balloon or Sohendra dilators (6 or 11 Fr), 1 or 2 stents (7 or 11.5 Fr), and sphincterotomy. Stents were changed at a 3 month interval unless the clinical condition necessitated more frequent change. Decision to abandon endoscopic therapy was made by the endoscopist and transplant team. Results: 23 [19 men and 4 women; mean age 47.7 (range 26 –70)] pts underwent endoscopic therapy for BS. The table below summarizes the type and outcome of the strictures. 3 of the 4 pts with nonanastomotic strictures had evidence of of hepatic artery thrombosis after their initial OLT. 82 ERCPs were performed [mean of 2.75/pt (SD 1.0)]. Mean follow up was 3.12 years (SD 2.24, range 0.5 to 9.6 yrs). 1 pt died secondary to recurrent hepatoma. Improvement in BS was judged as an increase of diameter of the stricture lumen. Mean length of endoscopic therapy was 310 days (SD 350). 4 pts are still undergoing endoscopic treatment. There were 7 procedural complications (cholangitis ⫽ 4, pancreatitis ⫽ 2, GI bleed ⫽ 1). For all pts treated, biochemical tests improved after each ERCP by a mean of 27.5 for AST (SD 91.1), 71.1 ALT (SD 257), Alk Phos 51 (SD 149.7), and T Bili 1.44 (SD 4.31). Conclusions: Treatment of simple post OLT anastomotic strictures endoscopically is effective. However, pts with the combination of biliary leak and nonanastomotic stricture did not respond to endoscopic therapy alone.
Abstracts
cells). while the chronic inflammatory response dominated in each case, a significant minority of PMN cells was always present. Amylase and lipase levels were similar in group A and B. Conclusions: Intraductal infusion of Gabexate Mesylate doesn’t produce any significant ductal, vascular or acinar injury. However, GM was not effective in preventing pancreatitis induction by ERCP in our dog model. We believe that the efficacy of intraductal GM should be tested in large controlled trials in human. 257 Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry without endoscopic retrograde cholangiopancreatography Syed T. Bin-Sagheer, M.D., Patrick G. Brady, M.D., Jay J. Mamel, M.D., Bruce Robinson, M.D., Division of Digestive Diseases, University of South Florida, Tampa, Florida. Purpose: Acute pancreatitis is a recognized complication of sphincter of Oddi manometry (SOM). Its frequency of occurrence has been reported in the range of 4% to 31%. In an earlier retrospective study done at this institution the incidence of pancreatitis was 9.3% in patients who only had SOM when compared to 26.1% in those patients who had SOM and ERCP with or without sphincterotomy at the same session. Looking at this data as a measure of quality improvement, at two university-affiliated hospitals, SOM was done without ERCP and if ERCP was required it was done at a different session. The purpose was to see if this practice decreases the incidence of pancreatitis. Methods: A prospective patient identification, retrospective chart review, of patients who underwent SOM without ERCP between May 98 and December 2000 was performed. SOM was performed using a triple lumen catheter with water perfusion at a rate of 0.25 ml/min using an Arndorfer pneumohydraulic capillary perfusion system. The data recorded included pancreatitis after SOM, pancreatitis after ERCP and sphincterotomy, average days in the hospital after pancreatitis and time between SOM and ERCP. Results: A total of 41 patients were studied. Three (7.32%) patients had pancreatitis after SOM. Five patients subsequently underwent ERCP and sphincterotomy and one (20%) patient had pancreatitis. The overall frequency of pancreatitis after SOM and any subsequent ERCP or sphincterotomy was 4/41 (9.78%). The average days in the hospital after pancreatitis ranged from 2– 4 days, mean 2.75 days. The time between SOM and ERCP if done ranged from 6 –20 days, mean 10.4 days. Conclusions: By adopting a protocol to perform SOM only and following with ERCP when required, we were able to decrease the incidence of pancreatitis considerably at our institutions. 258 Complete Choledocal Sphincterotomy (CCS) is effective in the treatment of recurrent pain post biliary sphincterotomy Rodrigo A Castillo, MD1, Manish Dhawan, MD1, Rad Agrawal, MD FACG 1 and TJ Ravi, MD 1*. 1Gastroenterology, Allegheny, General, Hospital, United States. Purpose: To recognize intestinal pseudo-obstruction secondary to Myotonic Muscular Dystrophy. Case presentation: A 24-year old white male with past medical history significant for asthma was admitted for a fourth episode of intestinal obstruction within the last 5 years. The first two episodes resolved with medical therapy. The third episode, 2 years ago, resulted in an exploratory laparotomy without any surgical pathology. His family history was significant for myotonic muscular dystrophy in his maternal grandmother and mother. The physical examination revealed bilateral temporal wasting, ptosis, atrophy of the sternocleidomastoid muscles and distal extremity weakness. Myotonia was noted in his hands. Abdomen was soft and scaphoid with diffuse tenderness.
AJG – Vol. 96, No. 9, Suppl., 2001
Laboratory data revealed contraction metabolic alkalosis, respiratory acidosis, hyperkalemia, hypocalcemia and acute renal failure. CPK, aldolase, FSH were elevated at 1196U/L (55-170U/L), 11.6U/L (0.4U/L), and 16.2MIU/ML (1-12MIU/L) respectively. Free and total testosterone levels were decreased at 2.6ng/dL (9-30ng/dL) and 60ng/dL (300-950ng/dL) respectively. DNA analysis showed 552 CTG trinucleotide repeats on the MPK gene consistent with full mutation for myotonic dystrophy. TSH, C-reactive protein, CBC and LFTs were within the normal range. EKG showed sinus tachycardia with mild intraventricular delay in leads II, III and aVF (QRS duration: 104ms). Patient had persistent obstructive picture. An abdominal CT showed extensive dilation of small bowel loops with a cut-off point at the distal small bowel. Exploratory laparotomy revealed adhesions and a thick fibrous band. They were lysed. Post-operatively, he continued to have high NG output for a prolonged period of time. Repeated plain X-rays of the abdomen and SBFT demonstrated persistent dilation of small bowel loops. No mechanical obstruction or mucosal abnormalities were identified. Patient eventually improved on IV prokinetic agents (metoclopramide and erythromycin). He was discharged on oral metoclopramide. Conclusions: Myotonic muscular dystrophy should be considered as a possible etiology of recurrent intestinal pseudo-obstruction. It is a rare autosomal dominant disorder which is always transmitted from the affected mother to her offspring. The condition is a product of an unstable CTG trinucleotide repeat in the MKP gene on chromosome 19q13.3. It affects all types of muscle. Most patients die between the ages of 40 and 60 years from cardiac and pulmonary complications. Treatment is symptomatic.
259 Outcomes of endoscopic management of post liver transplant biliary strictures Andrew T Catanzaro MD1, Gerard A Isenberg MD1*, Robert O’Shea MD1, Amitabh Chak MD1, Anthony Post MD1 and Michael V Sivak Jr. MD1. 1Division of Gastroenterology, University Hospitals of Cleveland Case Western Reserve University School of Medicine, Cleveland, Ohio, United States. Purpose: To evaluate the outcome of patients (pts) receiving endoscopic treatment for post liver transplant (OLT) biliary strictures (BS) at our institution. Methods: From 1989 to 2000, 296 pts had an OLT. Pts who had a choledocho-choledochostomy anastomosis and BS treated endoscopically were identified. Pts received a combination of dilation with balloon or Sohendra dilators (6 or 11 Fr), 1 or 2 stents (7 or 11.5 Fr), and sphincterotomy. Stents were changed at a 3 month interval unless the clinical condition necessitated more frequent change. Decision to abandon endoscopic therapy was made by the endoscopist and transplant team. Results: 23 [19 men and 4 women; mean age 47.7 (range 26 –70)] pts underwent endoscopic therapy for BS. The table below summarizes the type and outcome of the strictures. 3 of the 4 pts with nonanastomotic strictures had evidence of of hepatic artery thrombosis after their initial OLT. 82 ERCPs were performed [mean of 2.75/pt (SD 1.0)]. Mean follow up was 3.12 years (SD 2.24, range 0.5 to 9.6 yrs). 1 pt died secondary to recurrent hepatoma. Improvement in BS was judged as an increase of diameter of the stricture lumen. Mean length of endoscopic therapy was 310 days (SD 350). 4 pts are still undergoing endoscopic treatment. There were 7 procedural complications (cholangitis ⫽ 4, pancreatitis ⫽ 2, GI bleed ⫽ 1). For all pts treated, biochemical tests improved after each ERCP by a mean of 27.5 for AST (SD 91.1), 71.1 ALT (SD 257), Alk Phos 51 (SD 149.7), and T Bili 1.44 (SD 4.31). Conclusions: Treatment of simple post OLT anastomotic strictures endoscopically is effective. However, pts with the combination of biliary leak and nonanastomotic stricture did not respond to endoscopic therapy alone.