Clinical features and management of painless biliary type sphincter of Oddi dysfunction

Objective The objective of this study was to clarify the characteristics and management of painless biliary type sphincter of Oddi dysfunction (SOD). Methods From June 2002 to July 2018, 12 patients who had recurrent liver dysfunction with a dilated bile duct or acute cholestasis of unknown cause without biliary pain (painless SOD) were included in this study. These patients’ characteristics were compared with those of 36 patients with biliary type SOD based on the conventional definition (criteria-based SOD). Results Patients with painless SOD had significantly more prominent bile duct dilation than patients with criteria-based SOD (13.9 vs. 12.2 mm, respectively). Prophylactic biliary drainage was performed significantly more often in patients with painless SOD than criteria-based SOD (67% vs. 11%, respectively). The short-term effectiveness rate of endoscopic sphincterotomy, the symptom recurrence rate, and the incidence of adverse events were not significantly different between the two groups. Conclusions Painless SOD is a specific subtype of biliary SOD that causes recurring liver dysfunction or acute cholestasis without biliary pain. Endoscopic sphincterotomy was effective in the present study, but the relapse rate was as high as that in typical SOD.

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Determinants of long-term complications of endoscopic sphincterotomy are infections and high risk factors of bile duct and not sphincter of Oddi dysfunction

European Journal of Gastroenterology & Hepatology ◽

10.1097/meg.0000000000000295 ◽

2015 ◽

Vol 27 (4) ◽

pp. 412-418 ◽

Cited By ~ 2

Author(s):

Jianfeng Yang ◽

Hangbin Jin ◽

Weigang Gu ◽

Xiao Zhang ◽

Xiaofeng Zhang

Keyword(s):

Risk Factors ◽

High Risk ◽

Bile Duct ◽

Endoscopic Sphincterotomy ◽

Sphincter Of Oddi ◽

Sphincter Of Oddi Dysfunction ◽

High Risk Factors ◽

Oddi Dysfunction

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The effect of endoscopic sphincterotomy on the motility of the gallbladder and sphincter of Oddi in patients with acalculous biliary pain syndrome

Orvosi Hetilap ◽

10.1556/oh.2013.29555 ◽

2013 ◽

Vol 154 (8) ◽

pp. 306-313 ◽

Cited By ~ 1

Author(s):

Attila Szepes ◽

Zsolt Dubravcsik ◽

László Madácsy

Keyword(s):

Ejection Fraction ◽

Endoscopic Sphincterotomy ◽

Pain Syndrome ◽

Sphincter Of Oddi ◽

Gallbladder Motility ◽

Sphincter Of Oddi Dysfunction ◽

Biliary Pain ◽

Gallbladder Ejection Fraction ◽

Oddi Dysfunction ◽

Acalculous Biliary Pain

Introduction: Sphincter of Oddi dysfunction usually occurs after cholecystectomy, but it can sometimes be detected in patients with intact gallbladder too. The diagnostic value of the non-invasive functional tests is not established in this group of patients and the effects of sphincterotomy on transpapillary bile outflow and gallbladder motility are unknown. Aims: The aim of this study was to determine the effect of endoscopic sphincterotomy on the gallbladder ejection fraction, transpapillary bile outflow and the clinical symptoms of patients with acalculous biliary pain syndrome. Patients and methods: 36 patients with acalculous biliary pain syndrome underwent quantitative hepatobiliary scintigraphy, and all of them had decreased cholecytokinin-induced gallbladder ejection fraction. The endoscopic manometry of the sphincter of Oddi showed abnormal sphincter function in 26 patients who were enrolled the study. Before and after endoscopic sphincterotomy all patients had ultrasonographic measurement of cholecystokinin-induced gallbladder ejection fraction with and without nitroglycerin pretreatment and scintigraphy was repeated as well. The effects of sphincterotomy on gallbladder ejection fraction and transpapillary biliary outflow were evaluated. In addition, changes in biliary pain score with a previously validated questionnaire were also determined. Results: All 26 patients had decreased gallbladder ejection fraction before sphincterotomy measured with scintigraphy (19+18%) and ultrasound (16+9.7%), which was improved after nitroglycerin pretreatment (48.2+17%; p<0.005). Detected with both methods, the ejection fraction was in the normal range after sphincterotomy (52+37% and 40.8+16.5%), but nitroglycerin pretreatment failed to produce further improvement (48.67+22.2%, NS). Based on scintigraphic examination sphincterotomy significantly improved transpapillary biliary outflow (common bile duct half time 63±33 min vs. 37±17 min; p<0.05). According to results obtained from questionneries, 22 of the 26 patients gave an account of significant symptom improvement after sphincterotomy. Conclusions: Endoscopic sphincterotomy improves cholecystokinin-induced gallbladder ejection fraction, transpapillary biliary outflow as well as biliary symptoms in patients with acalculous biliary pain syndrome and sphincter of Oddi dysfunction. Cholecystokinin-induced gallbladder ejection fraction with nitroglycerin pretreatment, measured with ultrasonography can be useful to select a subgroup of patients who can benefit from sphincterotomy. Orv. Hetil., 2013, 154, 306–313.

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