Watson Rabindra R, Klapman Jason, Komanduri Srinadh, Shah Janak N, Wani Sachin, Muthusamy Raman
UCLA Medical Center - Digestive Diseases, Los Angeles, California, USA.
Moffitt Cancer Center - Gastrointestinal Oncology, Tampa, Florida, USA.
Endosc Int Open. 2016 Sep;4(9):E941-6. doi: 10.1055/s-0042-110789. Epub 2016 Aug 10.
Sphincter of Oddi manometry (SOM) is recommended in the evaluation of suspected Type II sphincter of Oddi dysfunction (SOD2), though its utility is uncertain. Little is known about the practice of expert endoscopists in the United States regarding SOD2.
An anonymous electronic survey was distributed to 128 expert biliary endoscopists identified from U.S. advanced endoscopy training programs.
The response rate was 46.1 % (59/128). Only 55.6 % received training in SOM, and 49.2 % currently perform SOM. For biliary SOD2, 33.3 % routinely obtain SOM, 33.3 % perform empiric sphincterotomy, and 26.3 % perform single session endoscopic ultrasound/endoscopic retrograde cholangiopancreatography (EUS/ERCP). In contrast, an equal number (35.1 %) favor SOM or single session EUS/ERCP for suspected acute idiopathic recurrent pancreatitis, while 19.3 % would perform empiric sphincterotomy. Those who perform SOM believe it to be important in predicting response to treatment compared with those who do not (71.8 % vs 23.1 %, P = 0.01). Yet only 51.7 % of this group performs SOM for suspected SOD2. Most (78.6 %) believe that < 50 % of patients report improvement in symptoms after sphincterotomy. Common reasons for not obtaining SOM included unreliable results (50 %), and procedure-related risks (39.3 %). Most (59.3 %) believe SOD2 is at least in part a functional disorder; only 3.7 % felt SOD is a legitimate disorder of the sphincter of Oddi.
Our survey of U.S. expert endoscopists suggests that SOM is not routinely performed for SOD2 and concerns regarding its associated risks and validity persist. Most endoscopists believe SOD2 is at least in part a functional disorder that will not respond to sphincterotomy in the majority of cases.
尽管Oddi括约肌测压法（SOM）在疑似II型Oddi括约肌功能障碍（SOD2）评估中的效用尚不确定，但仍被推荐使用。关于美国专家内镜医师对SOD2的诊疗情况知之甚少。
向从美国高级内镜培训项目中识别出的128位专家级胆道内镜医师发放匿名电子调查问卷。
回复率为46.1%（59/128）。仅有55.6%的人接受过SOM培训，49.2%的人目前开展SOM。对于胆道SOD2，33.3%的人常规进行SOM，33.3%的人进行经验性括约肌切开术，26.3%的人进行单次内镜超声/内镜逆行胰胆管造影术（EUS/ERCP）。相比之下，对于疑似急性特发性复发性胰腺炎，支持SOM或单次EUS/ERCP的人数相等（35.1%），而19.3%的人会进行经验性括约肌切开术。与不开展SOM的人相比，开展SOM的人认为其在预测治疗反应方面很重要（71.8%对23.1%，P = 0.01）。然而，该组中只有51.7%的人对疑似SOD2进行SOM。大多数人（78.6%）认为，括约肌切开术后<50%的患者症状会改善。未进行SOM的常见原因包括结果不可靠（50%）和与操作相关的风险（39.3%）。大多数人（59.3%）认为SOD2至少部分是一种功能性疾病；只有3.7%的人认为SOD是Oddi括约肌的一种真正疾病。
我们对美国专家内镜医师的调查表明，SOD2通常不进行SOM，对其相关风险和有效性的担忧依然存在。大多数内镜医师认为SOD2至少部分是一种功能性疾病，在大多数情况下对括约肌切开术无反应。
