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February 18, 1956


JAMA. 1956;160(7):521-528. doi:10.1001/jama.1956.02960420001001

• The sphincter of Oddi was cut in 319 patients whose repeated attacks of abdominal pain and other symptoms had led to the diagnosis of recurrent pancreatitis. The diagnostic criteria included high serum amylase level and diminished production of pancreatic juice in the secretin test.

It was believed that spasm in the sphincter would cause bile to enter the pancreatic duct system and provoke recurrent pancreatitis because the bile and pancreatic juice shared a common passageway before entering the duodenum. This passageway was demonstrated at operation in 316 patients, either by direct observation during transduodenal sphincterotomy, or by other means such as cholangiography.

Sphincterotomy must be accompanied by cholecystectomy, whether the gallbladder is normal or not. The operation abolished the pain caused by distention of biliary and pancreatic ducts and ended the attacks of severe pain of recurrent pancreatitis. It did not prevent attacks of acute pancreatitis that resulted from ingestion of alcohol or fats in 16 patients. It did, in most cases, stop the progressive destruction of the pancreas and make regeneration possible.