ERCP in Idiopathic Recurrent Acute Pancreatitis
ERCP in Idiopathic Recurrent Acute Pancreatitis
The therapeutic impact of ERCP with sphincterotomy in the management of patients with
 idiopathic recurrent acute pancreatitis (RAP) needs further study. The investigators
 conducted a single center, feasibility, randomized trial to determine 1) the role of
 pancreatic manometry in predicting future episodes of RAP and 2) differences in the efficacy
 of no, biliary (BES) or pancreatobiliary (dual) endoscopic sphincterotomy (DES).
Patients with idiopathic RAP, defined as ≥2 unexplained (per the treating physician) episodes
 of acute pancreatitis (based on standard criteria) requiring hospitalization, will be
 prospectively enrolled. All patients will undergo ERCP with manometry, with stratified
 randomization based on the assessment of pancreatic basal sphincter pressure. If <40mmHg, the
 patient will be randomized to sham or biliary sphincterotomy (BES). If ≥40mmHg, the patient
 will be randomized to BES or pancreatobiliary ("dual") sphincterotomy (DES).

 Patients and physicians will not be blinded to the assignment group. Patients will be
 followed for up to 10 years to determine 1) incidence of RAP requiring hospitalization (using
 standard definitions) or 2) interval development of chronic pancreatitis (CP).

 Differences between patients who did and did not develop RAP during follow-up will be
 compared to evaluate for factors associated with AP during follow-up.
Inclusion Criteria:

 -  Idiopathic recurrent acute pancreatitis, defined as two or more episodes requiring
 hospitalization

 -  ERCP with SOM planned

 Exclusion Criteria:

 -  Chronic pancreatitis

 -  Pancreas divisum

 -  Alternate etiology identified (e.g., CBD stone, IPMN)

 -  Inability to perform pancreatic manometry

 -  Pregnancy, age < 18, incarceration

 -  Inability to provide informed consent