Biliary sphincter of Oddi dysfunction: response rates after ERCP and sphincterotomy in a 5-year ERCP series and proposal for new practical guidelines.

INTRODUCTION

The diagnosis and management of sphincter of Oddi dysfunction (SOD) is challenging.

AIMS

Retrospective review of endoscopic retrograde cholangiopancreatographies (ERCPs) performed for biliary SOD between 2003 and 2007 and proposal for new management guidelines.

METHODS

Patients were identified from the ERCP database. All patients had a history of typical biliary pain and were classified into three groups - group 1: patients with dilated common bile duct and abnormal laboratory investigations at time of pain; group 2: either of the above; group 3: none of the above. All patients underwent ERCP and endoscopic sphincterotomy (ES). Sphincter of Oddi manometry was not carried out. Patients were contacted 18 months after procedure with regard to relief of pain and complications.

RESULTS

Seventy-two patients were included - 16.7% male and 83.3% female with an average age of 54.2 years. Ampullary stenosis was found in 76.2% of patients in group 1 and 70% in group 2 compared with 30% in group 3. In group 1, 90.5% of patients reported complete relief of pain compared with 75 and 50% in groups 2 and 3, respectively. Among them 55.6% of patients had previous cholecystectomy. Overall 85% of cholecystectomized patients and 81.3% of patients with an intact gallbladder had complete response to ES. There were no complications in all three groups.

DISCUSSION

Our findings are similar to other studies documenting response rates to ES in manometry proven SOD. Our simpler guidelines are more applicable to clinical practice. Group 3 remains the most challenging group. Risk and benefits of ERCP and ES should be discussed with patients in centres where sphincter of Oddi manometry is unavailable, noting that 50% of patients respond favourably to ES.