Outcomes of Sphincter of Oddi Manometry When Performed in Low Volumes

Results . 36 patients, 23 (23 type II sphincter of Oddi dysfunction (SOD), 13 type III SOD) underwent sphincter of Oddi manometry and were followed up for mean of 16 months. Nine Type II patients (90%) with elevated basal sphincter pressures noted symptom improvement after sphincterotomy compared with only 3 patients (43%) of the patients with normal basal pressures. In type III SOD, 7 patients had elevated basal SO pressure and underwent sphincterotomy. Three patients (43%) improved. There were six (16%) procedure-related complications. There were four cases of post ERCP pancreatitis (11%), all of which were mild. 1. Introduction

Sphincter of Oddi dysfunction (SOD) is a term used to describe epigastric or right upper quadrant pain syndromes attributed to dyskinesia or stenosis of the sphincter of Oddi. It is also commonly termed postcholecystectomy syndrome. Data has suggested that in patients with sphincter of Oddi stenosis, endoscopic sphincterotomy may be of symptomatic benefit [ 1 , 2 ]. However, identifying this patient population remains a challenge for physicians, both clinically and in research endeavors. Part of this challenge is the realization that SOD is likely a heterogenous group of disorders, influenced by other factors including psychological stressors, and overlaps with functional GI disorders including irritable bowel syndrome [ 3 , 4 ]. Presently, patients with suspected SOD are stratified into three different categories based on objective laboratory and radiologic findings coupled with pain [ 1 , 5 , 6 ].

Endoscopic retrograde cholangiopancreatography (ERCP) with sphincter of Oddi manometry (SOM) is considered the “gold standard” in the diagnosis of SOD. Sphincter hypertension, defined as basal sphincter pressures above 40 mmHg, is considered manometric evidence of SOD [ 7 ]. Current standard of practice is to perform endoscopic sphincterotomy without manometry in patients classified as type I SOD. These patients are felt to have papillary stenosis and will benefit from sphincterotomy without further investigation [ 8 ]. In patients categorized as type II SOD, documentation of abnormal biliary sphincter pressures with SOM is advised before proceeding to sphincterotomy. This recommendation is based largely on two randomized clinical trials [ 1 , 2 ]. Type III SOD is an even more challenging clinical situation as these patients lack objective evidence of sphincter dysfunction and tend to have overlap with underlying functional disorders, such as irritable bowel syndrome [ 3 , 4 ]. Current recommendations suggest that complete noninvasive diagnostic testing and empiric trials with antispasmotics or antidepressants be attempted prior to consideration of SOM [ 5 , 6 ]. Despite the above research, controversy remains regarding SOD and the use of SOM as a diagnostic tool.

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