Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Eur J Gastroenterol Hepatol. 2020 Aug;32(8):984-989. doi: 10.1097/MEG.0000000000001773.
The management of postcholecystectomy functional biliary pain or Type III sphincter of Oddi dysfunction is challenging. The Evaluating Predictors and Interventions in Sphincter of Oddi Dysfunction study has demonstrated the lack of efficacy of endoscopic sphincterotomy in the management of Type III sphincter of Oddi dysfunction.
Botulinum toxin injection to the sphincter of Oddi has been reported as being effective in uncontrolled studies. We sought to understand its pooled efficacy in controlling pancreaticobiliary pain in a systematic review and meta-analysis.
Our literature review yielded 10 studies (416 patients) and on random effects meta-analysis, the pooled efficacy of intrasphincteric botulinum toxin injection in alleviating symptoms of pancreaticobiliary was 49% (complete response) and 64% (partial response). One patient developed mild pancreatitis postprocedure and five patients needed postprocedure hospital admission for pain management. The effect of botulinum toxin injection was transient and in the majority of studies, and a positive response to botulinum toxin injection was followed by an endoscopic sphincterotomy. In one study, relapse of pain was managed by repeat botulinum toxin injections with success.
Intermittent botulinum toxin injection could be a potential option in the overall management strategy of patients with Type III sphincter of Oddi dysfunction, in conjunction with medical management with neuromodulatory medication.
胆囊切除术后功能性胆绞痛或第三型 Oddi 括约肌功能障碍的治疗颇具挑战。Oddi 括约肌功能障碍评估预测因素与干预研究表明，内镜下括约肌切开术在治疗第三型 Oddi 括约肌功能障碍方面效果不佳。
已有研究报道，Oddi 括约肌内注射肉毒毒素在非对照研究中有效。我们旨在通过系统评价和荟萃分析来了解其在控制胰胆疼痛方面的总体疗效。
我们的文献综述共纳入 10 项研究（416 例患者），采用随机效应荟萃分析，Oddi 括约肌内注射肉毒毒素缓解胰胆症状的总体疗效为 49%（完全缓解）和 64%（部分缓解）。1 例患者术后发生轻度胰腺炎，5 例患者因疼痛管理需要术后住院。肉毒毒素注射的效果是暂时的，且在大多数研究中，对肉毒毒素注射的积极反应后会进行内镜下括约肌切开术。在一项研究中，通过重复注射肉毒毒素成功治疗了疼痛复发。
间歇性肉毒毒素注射可能是第三型 Oddi 括约肌功能障碍患者整体治疗策略的潜在选择，与神经调节药物的药物治疗联合使用。
