Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy for sphincter of Oddi dysfunction:...

Aim: To analyze the short-term results of ERCP and endoscopic sphincterotomy (ES) in patients with sphincter of Oddi dysfunction (SOD).

Materials and Methods: We retrospectively analyzed the medical data of 120 cases of SOD with undergoing ERCP between January 2013 and December 2020. Mean values of factors with standard deviation were used. To compare mean values, Student's t-test was used. To compare non-parametric factors, the Chi-square test (χ2) was used. The value p<0.05 was considered statistically significant. All calculation were performed with SPSSR version 19 (IBM, USA).

Results: Biliary SOD was in 99 (82.5%) patients, mixed - bilio-pancreatic - in 21 (17.5%). Jaundice was in 59 (49.2%); dilatation of the common bile duct (CBD) was in 117 (97.5%); 18 (15%) patients had acute pancreatitis; 2 (1.7%) - cholangitis. All 117 (97.5%) patients with successful ERCP underwent ESP and/or Precut. Disappearance/reduction of abdominal pain was in 19 (90.5%) of 21 patients with pancreatic SOD, and in 60 (60.6%) of 99 patients with biliary SOD (χ2=6.872, p=0.009). Within 24-48 hours after ERCP, CBD size decreased from 10.9±2.3 to 8.2±1.7 mm (p<0.001). After 72-96 hours total bilirubin level decreased from 43.8±36.2 to 23.4±14.3 μmol/l (p<0.001). Adverse events associated with ERCP were pancreatitis (14.2%), bleeding (1.7%) and cholecystitis (0.8%). Among the 21 patients with bilio-pancreatic SOD, no worsening of pancreatitis symptoms or onset of acute pancreatitis was observed. All cases of post-ERCP pancreatitis occurred exclusively in patients with biliary SOD (χ2=4.201, p=0.041).

Conclusions: In SOD with signs of cholestasis, ES leads to a decrease of CBD size and normalization of bilirubinemia. Elimination of abdominal pain immediately after ES is more typical for bilio-pancreatic SOD compared to biliary SOD. The most common adverse event after ERCP and ES in patients with SOD is acute pancreatitis - specific for biliary SOD and not typical for bilio-pancreatic SOD.