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Sphincter of Oddi dysfunction.

G Boivineau1, J-M Gonzalez1, M Gasmi1

  • 1Service de gastroentérologie, Hôpital Nord, Chemin des Bourrelys, 13915 Marseille cedex 20, France.

Journal of Visceral Surgery
|February 8, 2022
PubMed
Summary
This summary is machine-generated.

Sphincter of Oddi dysfunction (SOD) is a disorder affecting the major papilla, causing biliary or pancreatic pain. Diagnosis involves excluding other conditions, and treatment varies from medication to endoscopic sphincterotomy, with careful consideration of risks and patient classification.

Keywords:
Biliary painCholecystectomySphincter of Oddi dysfunction

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Area of Science:

  • Gastroenterology
  • Hepatobiliary Medicine

Background:

  • Sphincter of Oddi dysfunction (SOD) is a benign disorder of the major papilla, often occurring post-cholecystectomy.
  • Symptoms include biliary pain, colic, or pancreatitis, with underlying causes being fibrotic stricture or motility disorders.
  • Diagnosis requires excluding choledocholithiasis or ampullary tumors.

Purpose of the Study:

  • To review the diagnostic approaches and treatment strategies for Sphincter of Oddi dysfunction.
  • To highlight the challenges in diagnosing SOD and the risks associated with interventions.

Main Methods:

  • Review of diagnostic modalities including ERCP, endoscopic ultrasound, magnetic resonance imaging, biliary manometry, and biliary scintigraphy.
  • Discussion of medical treatments (trimebutine, nitroglycerine) and endoscopic sphincterotomy.
  • Analysis of patient classification systems like the Milwaukee classification.

Main Results:

  • ERCP, endoscopic ultrasound, and MRI are crucial for differential diagnosis.
  • Biliary manometry is accurate but carries a risk of pancreatitis; biliary scintigraphy is safer but less sensitive.
  • Endoscopic sphincterotomy is indicated for specific patient groups (biliary pain with hepatic dysfunction/dilatation) due to associated risks and limited efficacy in others.

Conclusions:

  • Accurate diagnosis of SOD is essential, balancing invasive and non-invasive methods.
  • Treatment decisions, particularly endoscopic sphincterotomy, must consider the Milwaukee classification and potential complications.
  • Medical management is primary for functional complaints or psychosocial disabilities (Milwaukee type III).