Top 10 Highlights From ACG 2013
The last presentation in this list is a late-breaker abstract presented by Dr. Peter Cotton. These were the results of the EPISOD trial, a National Institutes of Health-funded sham-controlled trial of sphincterotomy in patients with suspected sphincter of Oddi dysfunction type 3. This trial involved 214 patients from 7 centers in the United States. They looked at postcholecystectomy patients who were very highly screened and with no history of pancreatitis. These patients were not taking daily narcotics, and they had no previous sphincter treatment. These patients were consented and underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary and pancreatic manometry, and then they were randomly assigned 2:1, irrespective of their manometry results, to sphincterotomy or sham procedure. Patients who were assigned to sphincterotomy with elevated pancreatic sphincter pressures were then randomly assigned to biliary or to biliary and pancreatic sphincterotomy. Success was defined as fewer than 6 disability days due to pain over a 3-month period of time, measured at 9 and 12 months. Patients were eligible for follow-up only if they were not taking narcotics. Most patients initially seemed to improve, so there was a buzz of success at least at first; but at the 1-year follow-up, 36% of the sham group and 22% of the sphincterectomy group met the criteria for success.
On preliminary analysis, the manometry results did not predict outcomes among the actively treated patients. The problem here is that the sham was no better than the active treatment, and the sphincterotomy is not more effective in postcholecystectomy patients with suspected sphincter of Oddi type 3. This changes the whole paradigm of manometry and sphincterotomy in this patient population. These patients were extremely well studied. Look for this study when it gets to publication. It was probably the highest-level scientific study presented at the ACG meeting.
That wraps up the hottest topics presented at ACG this year. I'm Dr. David Johnson. Thanks for listening.
EPISOD Results Disappoint
The last presentation in this list is a late-breaker abstract presented by Dr. Peter Cotton. These were the results of the EPISOD trial, a National Institutes of Health-funded sham-controlled trial of sphincterotomy in patients with suspected sphincter of Oddi dysfunction type 3. This trial involved 214 patients from 7 centers in the United States. They looked at postcholecystectomy patients who were very highly screened and with no history of pancreatitis. These patients were not taking daily narcotics, and they had no previous sphincter treatment. These patients were consented and underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary and pancreatic manometry, and then they were randomly assigned 2:1, irrespective of their manometry results, to sphincterotomy or sham procedure. Patients who were assigned to sphincterotomy with elevated pancreatic sphincter pressures were then randomly assigned to biliary or to biliary and pancreatic sphincterotomy. Success was defined as fewer than 6 disability days due to pain over a 3-month period of time, measured at 9 and 12 months. Patients were eligible for follow-up only if they were not taking narcotics. Most patients initially seemed to improve, so there was a buzz of success at least at first; but at the 1-year follow-up, 36% of the sham group and 22% of the sphincterectomy group met the criteria for success.
On preliminary analysis, the manometry results did not predict outcomes among the actively treated patients. The problem here is that the sham was no better than the active treatment, and the sphincterotomy is not more effective in postcholecystectomy patients with suspected sphincter of Oddi type 3. This changes the whole paradigm of manometry and sphincterotomy in this patient population. These patients were extremely well studied. Look for this study when it gets to publication. It was probably the highest-level scientific study presented at the ACG meeting.
That wraps up the hottest topics presented at ACG this year. I'm Dr. David Johnson. Thanks for listening.
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