The Role of the Flow Rate of the Pneumohydraulic System on Post–Sphincter of Oddi Manometry Pancreatitis

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Abstract
Manometry of sphincter of Oddi (SO) carries a risk of acute pancreatitis by a mechanism not yet clearly understood. This study attempted to evaluate the role of the flow rate of the perfusion system in the development of acute pancreatitis. During the past 60-months, we have performed 81 manometry studies of SO in 79 patients, 61 women and 18 men, who were referred for recurrent attacks of abdominal pain suggestive of SO dysfunction. All procedures were done by the same operator, utilizing the same instrumentation and similar premedication. In the first 54 studies, the pneumohydraulic system had a flow rate of 0.55 ml/min and a tank pressure of 15 lb/in2 while in the last 27 studies a flow rate of 0.27 ml/min and a pressure of 7.5 lb/in2 were employed. Acute pancreatitis was diagnosed after 16 (19.7%) procedures. Fourteen (26%) of them occurred after high-flow-rate perfusion. In contrast, only 2 (7%) of the 27 patients who had the procedure done at the low flow rate developed this complication (p < 0.05). There was no correlation between the occurrence of pancreatitis, clinical suspicion of SO dysfunction, and the underlying manometric profile of the sphincter. We conclude that the incidence of procedure-related pancreatitis after manometry of SO is higher than following diagnostic endoscopic retrograde cholangiopancreatography and that the flow rate in the perfusion system is a precipitating factor in the development of this complication.

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