DIAGNOSIS AND TREATMENT OF SPHINCTER OF ODDI DYSFUNCTION :PAPILLARY STENOSIS AND BILIARY DYSKINESIA

Abstract

Sphincter of Oddi dysfunction (SOD) is one cause of post-cholecystectomy syndrome and biliary pain. It is a diagnostic and therapeutic challenge. The syndrome is often associated with a variety of other gastrointestinal dysmotility disorders. The Milwaukee classification divides patients with biliary pain into three categories. Biliary Type I patients show the entire objective signs of disturbed biliary outflow : elevated liver function tests dilated common bile duct (CBD) and delayed contrast drainage during ERCP. Biliary Type II patients have biliary pain along with one or two of the criteria from Biliary Type I. Biliary Type III patients have only biliary pain, with no other abnormalities. Recently the huge increase of cholecystectomy by Laparoscopy has increased the number of patients with post-cholecystectomy syndrome and possible Sphincter of Oddi dysfunction (SOD). We described eight patients with Biliary Type I SOD treated by endoscopic sphincterotomy (EST) and confirmed that Biliary Type I SOD is actually papillary stenosis. After seeing several patients with sickle cell disease, concomitant papillary stenosis, and common duct stones, we modified the definition of papillary stenosis to include patients with biliary stones. This paper will focus primarily on SOD syndrome, papillary stenosis, and the diagnostic and therapeutic approaches-in particular endoscopic sphincterotomy.