Sphincter of Oddi dysfunction in patients with intact gallbladder: therapeutic response to endoscopic sphincterotomy

Increasing evidence exists of the occurrence of sphincter of Oddi dysfunction in patients with an intact gallbladder. Optimal therapy for such patients has not been defined. From 1989 to 1991, 35 patients with sphincter of Oddi dysfunction (abnormal basal sphincter pressure > 40 mm Hg) and an intact gallbladder were identified. The patients with abnormal ductography (except for duct dilation), pancreas divisum, or pancreato-biliary malignancy were excluded. All patients had disabling upper abdominal pain, which was quantified on a 0 = none to 10 = severe pain scale. All patients received standard endoscopic biliary sphincterotomy and were followed up for 4 to 26 months with a mean of 13 months. Initially, 27 of 35 patients (77%) showed at least 50% improvement in the pain score, whereas only 15 of the 27 remained improved throughout the follow-up interval. Patients who were unimproved or had relapses were offered cholecystectomy and 11 patients underwent the procedure. These patients were followed up after cholecystectomy for 2 to 24 months, with a mean of 13 months. Eight of 11 were improved. In summary, the combination of endoscopic sphincterotomy and selective cholecystectomy and minimal medical treatment resulted in a good and excellent response rate of 68%. Better techniques are needed to select patients who will respond to these therapies.