Conferences and Medical Updates
- Biliary and pancreatic SOD
- SOD evaluation – invasive and non invasive
- Hopkins scintographic score for biliary SOD dynfunction. 100% sensitivity and specificity. Drawback is does not evaluate pancreatic SOD.
- Secretin stimulated MRCP – 0.5 cm increase in PD size suggests pancreatic SOD.
- ERCP 30% of patients will develop pancreatitis in SOD. DO NOT DO ERCP.
- Chronic abd. pain – 60% of them had SOD. 10% isolated biliary SOD, 20% had ioslated pancreatic SOD and 30% had both.
- Rx is antispasomodics – smooth muscle relaxants, botox injections, CCBs
- Gold standards is biliary sphincterotomy.
- Type 2 and type 3 biliary – do sphincterotomy.
- Causes of pain after sphincterotomy – residual SODor pancreatic SOD or chronic pancreatitis or non pancreaticobiliary cause.
- Should patients get pancreatic sphincterotomy with biliary sphincterotomy ? On going study.