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Biliary and gallbladder dyskinesia
1John Baillie, MB, ChB, FRCP Division of Gastroenterology, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA. jbaillie@wfubmc.edu.
Current Treatment Options in Gastroenterology
|September 1, 2007
Summary
Gallbladder dyskinesia and sphincter of Oddi dysfunction are motility disorders causing biliary pain. Diagnosis involves imaging and functional studies, with treatments ranging from cholecystectomy to endoscopic sphincterotomy.
Area of Science:
- Gastroenterology
- Biliary tract disorders
- Motility disorders
Background:
- Gallbladder dyskinesia and sphincter of Oddi dysfunction (SOD) are increasingly recognized motility disorders.
- Gallbladder dyskinesia causes biliary pain without gallstones, while SOD involves the sphincter of Oddi.
- Improved diagnostic technology aids in identifying these conditions.
Purpose of the Study:
- To review the diagnosis and management of gallbladder dyskinesia and SOD.
- To highlight diagnostic criteria and treatment options for these biliary motility disorders.
Main Methods:
- Diagnostic work-up includes laboratory tests, imaging (to exclude gallstones), and functional studies like radionuclide scans for gallbladder ejection fraction.
- Sphincter of Oddi manometry (SOM) is the gold standard for assessing biliary SOD.
- Patients with SOD are subtyped based on clinical presentation and diagnostic findings.
Main Results:
- Gallbladder ejection fraction <40% indicates abnormal function, with cholecystectomy offering high symptom relief (94-98%).
- Type I SOD (stenosis) patients show >/=90% benefit from endoscopic biliary sphincterotomy (EBS), making SOM unnecessary.
- Pancreatic SOD patients may benefit from endoscopic pancreatic sphincterotomy, with surgery considered for recurrent stenosis.
Conclusions:
- Gallbladder dyskinesia and SOD require specific diagnostic approaches for effective management.
- Endoscopic therapies are highly effective for specific subtypes of SOD.
- Accurate diagnosis guides treatment decisions, improving patient outcomes for biliary pain syndromes.
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