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Sphincter of Oddi dysfunction and pancreatitis
M T McLoughlin1, R M S Mitchell
1Department of Gastroenterology, Belfast City Hospital, Northern Ireland.
World Journal of Gastroenterology
|December 18, 2007
Summary
Sphincter of Oddi dysfunction (SOD) causes pain due to abnormal sphincter contractility. Endoscopic sphincterotomy (ES) benefits many patients, particularly with type I SOD, but further research is needed for types II and III.
Area of Science:
- Gastroenterology
- Hepatology
- Pancreatology
Background:
- Sphincter of Oddi dysfunction (SOD) encompasses heterogeneous pain syndromes linked to abnormal sphincter contractility.
- SOD is sub-classified into biliary and pancreatic types (I, II, III) using the Milwaukee classification.
- SOD is associated with increased risks of acute pancreatitis and post-ERCP pancreatitis.
Purpose of the Study:
- To review the pathophysiology, classification, and management of Sphincter of Oddi dysfunction.
- To evaluate the efficacy of endoscopic sphincterotomy (ES) in managing different types of SOD.
- To discuss the relationship between SOD and pancreatitis and future research directions.
Main Methods:
- Review of existing literature on Sphincter of Oddi dysfunction.
- Analysis of the Milwaukee classification system for SOD.
- Evaluation of outcomes following endoscopic sphincterotomy (ES).
Main Results:
- Type I SOD shows significant benefit from ES (55%-95%), often without requiring manometry.
- ES benefit is less predictable for Type II and III SOD, necessitating thorough pre-procedural evaluation.
- Pancreatic SOD management via sphincterotomy can benefit up to 88% of patients.
Conclusions:
- Current SOD classification may require revision to encompass both biliary and pancreatic aspects.
- Further research is crucial to elucidate the mechanisms linking SOD and pancreatitis.
- Identifying patient factors predicting response to endoscopic therapy is essential.
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