Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Gastroenterology, Advanced Endoscopy, Indiana University School of Medicine, Indianapolis, Indiana.
J Surg Res. 2019 Jun;238:41-47. doi: 10.1016/j.jss.2019.01.013. Epub 2019 Feb 6.
Management of Sphincter of Oddi Dysfunction (SOD) requires advanced techniques (endoscopic retrograde cholangiopancreatography via gastrostomy [GERCP]) after Roux-en-Y gastric bypass (RYGB) for obesity. Transduodenal sphincteroplasty (TS) is also performed yet carries the risks of surgery. We hypothesized that TS would have increased morbidity and mortality but provide a more durable remission of symptoms.
All patients between 2005 and 2016 with RYGB for obesity undergoing endoscopic or surgical management for type I or II SOD were included in the study. Patients with type III SOD, or who underwent RYGB for nonobesity indications, were excluded.
Thirty-eight patients were identified. GERCP was initially performed in 17 patients, whereas TS was performed in 21. Thirty-day mortality was 0% in our cohort, and 30-d morbidity was similar between GERCP and TS (29% versus 10%; P = 0.207). Resolution of symptoms after initial therapy was seen in 41% of GERCP (7/17) and 67% of TS (14/21) (P = 0.190), respectively, and overall after 35% (8/23) and 64% (16/24) of procedures performed (P = 0.042). Symptom resolution, as defined by the median ratio of days of total remission by total days of observed follow-up, was shorter after initial and all interventions with GERCP compared with TS (0.67 versus 1.00, P = 0.036 and 0.52 versus 1.00, P = 0.028, respectively).
Endoscopic and surgical treatment of SOD had similar morbidity and mortality. However, treatment success and duration of remission was higher in those treated with surgery.
肥胖患者行 Roux-en-Y 胃旁路术（RYGB）后，Oddi 括约肌功能障碍（SOD）的管理需要先进的技术（经胃 Gastrostomy 的内镜逆行胰胆管造影术 [GERCP]）。经十二指肠括约肌成形术（TS）也有实施，但存在手术风险。我们假设 TS 会增加发病率和死亡率，但会提供更持久的症状缓解。
研究纳入了 2005 年至 2016 年间因肥胖而行 RYGB 并因 I 型或 II 型 SOD 而行内镜或手术治疗的所有患者。排除了 III 型 SOD 患者或因非肥胖指征而行 RYGB 的患者。
共确定了 38 例患者。17 例患者最初行 GERCP，21 例患者行 TS。本队列中 30 天死亡率为 0%，GERCP 和 TS 的 30 天发病率相似（29%比 10%；P=0.207）。初次治疗后症状缓解分别见于 GERCP（7/17，41%）和 TS（14/21，67%）（P=0.190），初次治疗和所有治疗后（8/23，35%和 16/24，64%）的总体缓解率（P=0.042）。根据观察随访期间总缓解天数与总天数的中位数比值，GERCP 与 TS 相比，初次和所有干预的症状缓解时间更短（0.67 比 1.00，P=0.036 和 0.52 比 1.00，P=0.028）。
内镜和手术治疗 SOD 的发病率和死亡率相似。然而，手术治疗的成功率和缓解持续时间更高。
