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Low Yield of Significant Findings on Endoscopic Retrograde Cholangiopancreatography in Patients with Pancreatobiliary Pain and No Objective Findings

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Abstract

Background

Due to the challenging nature of the type III sphincter of the Oddi dysfunction (SOD) patient, the suspected low diagnostic yield from endoscopic retrograde cholangiopancreatography (ERCP), the high complication rate, and the potential for litigation it is surprising that diagnostic ERCP continues to be performed in this patient population.

Aims

The purpose of this study was to determine the incidence of significant findings on ERCP alone in patients with disabling abdominal pain of suspected pancreatobiliary origin and no objective findings.

Methods

Entry criteria of this study included: (1) ERCP with attempt at visualization of both the biliary tree and pancreatic duct, (2) suspected of having abdominal pain of pancreatobiliary origin, (3) biliary or pancreatic type III by the modified Geenen–Hogan classification, (4) never undergone sphincterotomy, (5) attempted manometry of both sphincters. A total of 265 patients met entry criteria.

Results

Significant findings were found in seven patients (2.6 %): choledococoele (1), anomalous pancreatobiliary ductal union (2), mild-moderate chronic pancreatitis (2), and pancreatic duct filling defect suspicious for IPMN (2). Potentially significant in 25 patients (9.4 %) were: equivocal chronic pancreatitis (1), incomplete (4) and complete pancreas divisum (20). SOD was diagnosed in 77.7 %. 11.3 % had undergone a previous diagnostic ERCP.

Conclusion

ERCP in this high-risk population requires detailed informed consent, availability of SOM to increase the diagnostic yield, and skills in placing prophylactic pancreatic stents. It is our belief that patients without objective findings of pancreatobiliary disease that would explain their subjective complaints should not undergo diagnostic ERCP.

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Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

SOD:

Sphincter of Oddi dysfunction

SOM:

Sphincter of Oddi manometry

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

ALP:

Alkaline phosphatase

mm:

Millimeters

CT:

Computed tomography scan

MRCP:

Magnetic resonance cholangiopancreotography

EUS:

Endoscopic ultrasound

ASGE:

American Society for Gastrointestinal

NIH:

National Institute of Health

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None of the contributing authors have any disclosures related to this work.

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Authors and Affiliations

  1. Division of Gastroenterology, Indiana University School of Medicine, 1050 Wishard Blvd, RG 4100, Indianapolis, IN, 46202-2872, USA

    Timothy D. Imler, Stuart Sherman, Lee McHenry, Evan L. Fogel, James L. Watkins & Glen A. Lehman

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  1. Timothy D. Imler
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  2. Stuart Sherman
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  3. Lee McHenry
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  4. Evan L. Fogel
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  5. James L. Watkins
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  6. Glen A. Lehman
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Correspondence to Timothy D. Imler.

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Imler, T.D., Sherman, S., McHenry, L. et al. Low Yield of Significant Findings on Endoscopic Retrograde Cholangiopancreatography in Patients with Pancreatobiliary Pain and No Objective Findings. Dig Dis Sci 57, 3252–3257 (2012). https://doi.org/10.1007/s10620-012-2250-0

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  • DOI: https://doi.org/10.1007/s10620-012-2250-0

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