Common bile duct sphincter of Oddi stenting in patients with suspected sphincter dysfunction

Some patients seem to have symptoms or other findings that imply that they have sphincter of Oddi dysfunction, but when the sphincter pressure is measured, the basal resting pressure is not greater than 40 mm Hg. Because empiric sphincterotomy can alleviate some of these patients'symptoms, it is suspected that they have intermittent spasm or dysfunction. Prolonged stenting of the sphincter would prevent symptoms in patients with this intermittent disorder. Thus, one could determine which patients would benefit from a sphincterotomy without subjecting all the patients to the risk of sphincterotomy.

Twenty-one patients with suspected sphincter of Oddi dysfunction were studied. All had basal sphincter of Oddi pressures < 40 mm Hg. The gallbladder was in situ in three. The others had persistent abdominal pain after cholecystectomy. Benefit was defined as no symptoms for 2 months after stent placement, followed by continued lack of symptoms once a sphincterotomy was performed.

Nine patients benefited and 12 did not. One relapsed, but benefited from a repeat sphincterotomy. Eight patients (38%) met criteria for pancreatitis after stent placement. Two had severe pancreatitis with pseudocyst development. There were no sphincterotomy-related complications.

The results suggest that patients without basal resting sphincter of Oddi pressure criteria may have intermittent spasm or dysfunction which can be deduced by achieving benefit after stenting, but the risk of pancreatitis from this technique as described is too high to recommend stenting as a routine method for detecting patients with intermittent sphincter dysfunction/spasm. Alternate methods need to be developed to identify these patients.