Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction?
Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction?
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DOI：
10.1016/j.gie.2013.11.037
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发表时间：
2014-05-01
影响因子：
7.7
通讯作者：
Elta, Grace H.
中科院分区：
文献类型：
--
作者：
Romagnuolo, Joseph;Cotton, Peter B.;Elta, Grace H.
背景资料：胆胰型胆囊切除术后疼痛，没有显着异常的影像学和实验室检查结果，已被归类为“可疑”括约肌功能障碍（SOD）III型。“测压”SOD的临床预测因素对于避免不必要的ERCP是重要的，但目前尚不清楚。目的：评估哪些临床因素与Oddi括约肌测压（SOM）异常相关。设计：前瞻性，横断面。设置：三级。患者：共有214例疑似SOD III型患者在7 U. S.干预：疼痛和胆囊描述，心理社会/功能障碍问卷调查。主要结果测量：异常SOM结果。单变量和多变量分析评估临床特征和outcome.Results之间的关联：该队列是92%的女性，平均年龄为38岁。5%的患者基线胰腺酶升高; 9%的患者有轻微肝酶异常。90%的患者疼痛发生在右上象限（RUQ）（48%也发生在上腹部）; 51%的患者报告每日腹部不适。五十六人（在过去的90天中）平均服用麻醉品33天。只有不到10%的人经历过抑郁或焦虑。功能障碍是常见的。在ERCP检查中，64%的pSOM结果异常（34%的两个括约肌，21%的胆道正常），36%的pSOM结果正常，75%的至少有一个括约肌异常。人口统计学因素、胆囊病理、胰胆酶升高、功能障碍和疼痛模式不能预测SOM异常。焦虑，抑郁，和较差的应对更常见的患者与正常SOM的结果（不显着的多变量分析）。局限性：概括性。结论：病人和疼痛因素和心理并发症不预测SOM结果在ERCP怀疑III型SOD。（临床试验注册号：NCT 00688662。）
Background: Biliopancreatic-type postcholecystectomy pain, without significant abnormalities on imaging and laboratory test results, has been categorized as "suspected" sphincter of Oddi dysfunction (SOD) type III. Clinical predictors of "manometric" SOD are important to avoid unnecessary ERCP, but are unknown.Objective: To assess which clinical factors are associated with abnormal sphincter of Oddi manometry (SOM).Design: Prospective, cross-sectional.Setting: Tertiary.Patients: A total of 214 patients with suspected SOD type III underwent ERCP and pancreatic SOM (pSOM; 85% dual SOM), at 7 U. S. centers (from August 2008 to March 2012) as part of a randomized trial.Interventions: Pain and gallbladder descriptors, psychosocial/functional disorder questionnaires.Main Outcome Measurements: Abnormal SOM findings. Univariate and multivariate analyses assessed associations between clinical characteristics and outcome.Results: The cohort was 92% female with a mean age of 38 years. Baseline pancreatic enzymes were increased in 5%; 9% had minor liver enzyme abnormalities. Pain was in the right upper quadrant (RUQ) in 90% (48% also epigastric); 51% reported daily abdominal discomfort. Fifty-six took narcotics an average of 33 days (of the past 90 days). Less than 10% experienced depression or anxiety. Functional disorders were common. At ERCP, 64% had abnormal pSOM findings (34% both sphincters, 21% biliary normal), 36% had normal pSOM findings, and 75% had at least abnormal 1 sphincter. Demographic factors, gallbladder pathology, increased pancreatobiliary enzymes, functional disorders, and pain patterns did not predict abnormal SOM findings. Anxiety, depression, and poorer coping were more common in patients with normal SOM findings (not significant on multivariate analysis).Limitations: Generalizability.Conclusions: Patient and pain factors and psychological comorbidity do not predict SOM results at ERCP in suspected type III SOD. (Clinical Trial registration number: NCT00688662.)