Hyun Jong Jin, Kozarek Richard A
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Curr Opin Gastroenterol. 2018 Sep;34(5):282-287. doi: 10.1097/MOG.0000000000000455.
To review important manuscripts published over the previous 2 years relative to sphincter of Oddi dysfunction (SOD).
The long-term outcomes of the Evaluating Predictors and Interventions of SOD (EPISOD) trial further substantiated results from the initial EPISOD study, reinforcing that neither endoscopic retrograde cholangiopancreatography-manometry nor endoscopic sphincterotomy are appropriate for SOD type III. Pain management in the latter patients has reverted to neuromodulating agents, and recent studies have suggested a role for duloxetine and potentially acupuncture. The functional role of the sphincter of Oddi has been reiterated with a report demonstrating a higher clinically significant pancreatic fistula rate in distal pancreatectomy patients treated with higher doses of postoperative narcotics. Moreover, the injection of periampullary botulinum toxin preoperatively has been shown to decrease these fistulas in a pilot trial. Additional studies have reinforced that eluxadoline can cause sphincter of Oddi spasm and pancreatitis. In contrast to approaching patients with acute relapsing pancreatitis using endoscopic retrograde cholangiopancreatography and manometry, previous and current studies suggest that endoscopic ultrasound should be done first and the role of SOD in idiopathic acute relapsing pancreatitis remains controversial. Finally, there remain widespread disparities in practice patterns in the approach to patients currently classified as SOD type II.
In contrast to historical manuscripts which stress the classical definitions of three types of SOD and their consequences, more recent manuscripts on this topic have focused on improving surgical outcomes based on the physiologic role of sphincter of Oddi, as well as the pharmacologic causes and treatments of SOD. The simplistic view that SOD, however it has been diagnosed, requires biliary or dual sphincterotomy is just that, simplistic and potentially misguided.
回顾过去两年发表的与Oddi括约肌功能障碍（SOD）相关的重要手稿。
SOD评估预测因素和干预措施（EPISOD）试验的长期结果进一步证实了最初EPISOD研究的结果，强化了内镜逆行胰胆管造影测压术和内镜括约肌切开术均不适用于III型SOD的观点。后一组患者的疼痛管理已转向神经调节药物，最近的研究表明度洛西汀和可能的针灸有一定作用。一份报告重申了Oddi括约肌的功能作用，该报告显示，接受高剂量术后麻醉剂治疗的远端胰腺切除术患者临床上显著的胰瘘发生率更高。此外，一项初步试验表明，术前注射壶腹周围肉毒杆菌毒素可减少这些瘘管。更多研究强化了依鲁卡多啉可导致Oddi括约肌痉挛和胰腺炎的观点。与使用内镜逆行胰胆管造影和测压术治疗急性复发性胰腺炎患者不同，既往和当前的研究表明应首先进行内镜超声检查，SOD在特发性急性复发性胰腺炎中的作用仍存在争议。最后，目前归类为II型SOD患者的治疗模式在实践中仍存在广泛差异。
与强调三种类型SOD的经典定义及其后果的历史手稿不同，关于该主题的最新手稿侧重于基于Oddi括约肌的生理作用改善手术结果，以及SOD的药理学原因和治疗方法。那种认为无论如何诊断，SOD都需要进行胆道或双括约肌切开术的简单观点，就是如此简单，而且可能具有误导性。
