[Management of hypertensive dyskinesia of Oddi's sphincter. Correlation between the frequency of complications from endoscopic sphincterotomy and the diameter of the common bile duct].

OBJECTIVES

to evaluate the treatment possibilities in different forms of sphincter of Oddi dysfunction (SOD), in particularly that of the hypertonic sphincter of Oddi dyskinesia (HOD, biliary type group III). In the first part of retrospective evaluation the higher complication rate of endoscopic sphincterotomy (EST) and its probable causes were analysed.

MATERIAL AND METHODS

The frequency and reasons of post-EST complications were retrospectively evaluated in a three-year (1990-1992) EST material of two gastroenterological departments using identical treatment principles and methods. Endoscopic sphincterotomies performed for bile duct stone extraction or treatment of HOD in cholecystectomized patients were included only. The data of 308 patients were analysed regarding two areas: 1. EST was performed for HOD treatment in 20 patients, and in 288 patients for stone removal, 2. the diameter of common bile duct was found non-dilated in 40 patients, and dilated in 268 patients, respectively.

RESULTS

1. The frequency of complications in the group of patients with EST for HOD treatment was significantly higher: 8/20 (40%) vs. 17/288 (5.9%) (p < 0.01). 2. There was also a significant difference in the percentage of total complications between the patients of nondilated bile ducts and those patients with dilated bile ducts: 8/268 (3.3%) vs. 17/40 (42.50%) (p < 0.01), detailed: bleeding: 4/268 vs. 6/40, pancreatitis: 4/268 vs. 10/40, and perforation: 0 vs. 1/40.

CONCLUSIONS

Therapeutic endoscopic sphincterotomy is more hazardous in patients with non-dilated bile ducts, thus evidently also in patients suffering from the biliary III. type (hypertonic Oddi-sphincter dyskinesia) of sphincter of Oddi dysfunctions.