Is endoscopic sphincterotomy avoidable in patients with sphincter of Oddi dysfunction?

Area of Science:

• Gastroenterology
• Hepatology
• Surgical Innovation

Background:

• Sphincter of Oddi dysfunction (SOD) is a condition affecting biliary and pancreatic outflow.
• Endoscopic sphincterotomy (ES) is an effective treatment for SOD but carries a 20% morbidity rate.
• Optimal management strategies for SOD, especially after failed medical therapy, require further investigation.

Purpose of the Study:

• To evaluate the utilization rate of endoscopic sphincterotomy (ES) for suspected sphincter of Oddi dysfunction (SOD).
• To assess the outcomes of a 1-year trial of medical management for SOD.
• To determine the proportion of patients with prolonged hepato-duodenal transit time (HDTT) undergoing ES.

Main Methods:

• A prospective study included 59 post-cholecystectomy patients with suspected SOD.
• Patients underwent a 1-year trial of medical management.
• Endoscopic sphincterotomy was offered to patients with persistent symptoms or unsuccessful medical treatment.

Main Results:

• Medical management was effective in 45-71.4% of patients across Milwaukee classification groups.
• Only 14 out of 21 patients with unsuccessful medical treatment proceeded to ES.
• Of those who underwent ES, 12 out of 14 (85.7%) were cured, and prolonged HDTT was more common in the ES group (P=0.03).

Conclusions:

• A minority of patients (23%) with suspected SOD underwent ES after a 1-year medical management trial.
• Despite a high prevalence of prolonged HDTT (54%), ES utilization was low.
• These findings suggest a conservative approach to ES in SOD management following medical therapy.