Sphincterotomy Doesn't Relieve Pain After Cholecystectomy
(HealthDay News) — For patients who have undergone cholecystectomy and experience abdominal pain, sphincterotomy is not associated with pain relief, according to a study published in the May 28 issue of the Journal of the American Medical Association.
Peter B. Cotton, MD, from the Medical University of South Carolina in Charleston, and colleagues conducted a multicenter, sham-controlled, randomized trial to examine whether endoscopic sphincterotomy reduces pain for patients with pain after cholecystectomy. The study involved 214 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) and were randomly assigned to undergo sphincterotomy (141 patients) or sham therapy (73 patients), regardless of manometry findings.
The researchers found that 37 and 23% of patients in the sham treatment and sphincterotomy groups, respectively, experienced successful treatment (adjusted risk difference, −15.6%; P=0.01). There was no significant difference in the proportion of patients who underwent repeat ERCP interventions in the treated versus sham group (26 and 34%, respectively; P=0.22). There was no correlation between manometry results and outcome. No clinical subgroups benefited more than others from sphincterotomy. Pancreatitis occurred in 11% of those who underwent primary sphincterotomies and 15% of the sham group.
"In patients with abdominal pain after cholecystectomy undergoing ERCP with manometry, sphincterotomy versus sham did not reduce disability due to pain," the authors write. "These findings do not support ERCP and sphincterotomy for these patients."
Several authors disclosed financial ties to the medical device industry.