Sphincter questions - to Kara

June 9, 2005

In my experience, the ERC with manometry went well - with no

complications. I was not admitted prior to the procedure but was

kept for 23 hour observation afterwards. I too had general

anesthesia. I always have for the one ERC and all my

ERCPs...not sure why as I hear that most people have

conscious sedation only. I know I prefer GA.

As far as complications from the procedure, it is hard to predict.

If the procedure is limited to just the biliary portion of the SO then

you may have a reduced risk of post-ERC complications. If the

endoscopists opts to inject dye into your pancreas, then you can

be at an increased risk of post-ERCP complications. It also

depends on how hard it is to get the instruments into your ducts.

If there is alot of manipulation, then you are at a higher risk. As

well as if you get both sphincters cut (biliary and pancreatic).

There are so many variables that it can be dramatically different

between patients or even in the same patient but on different

days. In my experience, the ERC with SO sphincterotomy did not

give me any complications at all. But when I had the full ERCP

with pancreatic sphincterotomy three weeks later I had very

painful post-ERCP pancreatitis, although medically a mild case,

to me it was pretty significant. The factors that seem to cause

this was that he couldn't get access to my duct easily so he really

had to struggle and most likely traumatized the opening. In

addition, he used a balloon to dilate the opening before he made

the cut so again, that has a greater likelihood of causing trauma.

And finally he put a stent in (to be exchanged in 8 weeks).

As far as offering a cure......since the SO was cut I have only had

one incident of biliary colic. That was 13 months after the

procedure. I have now gone 7 months biliary colic free. So at this

time I consider the procedure a success. However, the

sphincterotomy has not done anything to relieve my pancreatic

pain. I still have significant daily pain and nausea. So I guess in

my case I would summarize it as working wonderfully for the

acute attacks of biliary colic but doing nothing for the pain of

chronic pancreatitis.

laurie

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