Predictors of Outcomes After Biliary and Pancreatic Sphincterotomy for Sphincter of Oddi Dysfunction

Freeman, Martin L.; Gill, Muzaffar Latif; Overby, Carol; Cen, Ye-Ying

doi:10.1097/01.mcg.0000225584.40212.fb

Cited by 51 publications

(27 citation statements)

References 51 publications

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“…This dual classification has prompted a call for a single overall classification system from some quarters. A recently published trial [89] has also shown that other patient factors such as age, opioid use, delayed gastric emptying and pancreatic manometry are more important predictors of response to dual sphincterotomy than abnormal liver function tests and a dilated ductal system, on which the traditional classification system is heavily based. Further large prospective trials are required to identify other potential patient factors that may help predict response to therapy; such factors should be taken into account in any future overhaul of the current classification system.…”

Section: Resultsmentioning

confidence: 99%

“…However, other factors should also be taken into account. In a recent trial which included patients with biliary typesⅠ, Ⅱ and Ⅲ SOD, all 121 patients underwent biliary sphincterotomy [89] and 49 patients had pancreatic sphincterotomy at initial or subsequent ERCP if there was a history of abnormal pancreatic manometry in the setting of continuous pain, persistent pain after biliary sphincterotomy or a history of amylase elevation. There was no significant difference in patient response according to Milwaukee classification.…”

Section: Pancreatic Type Sodmentioning

confidence: 99%

See 1 more Smart Citation

Sphincter of Oddi dysfunction and pancreatitis

Mcloughlin

Mitchell²

2007

WJG

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Section: Resultsmentioning

confidence: 99%

Section: Pancreatic Type Sodmentioning

confidence: 99%

Sphincter of Oddi dysfunction and pancreatitis

Mcloughlin

Mitchell²

2007

WJG

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“…Freeman et al performed multivariate analysis to predict response to ES [53]. The group found gastroparesis, daily narcotic use and age less than 40 to be poor predictors of response.…”

Section: Long-term Outcomes Per Milwaukee Typementioning

confidence: 97%

“…Surgical sphincterotomy is usually reserved when endoscopic therapy is not available or for restenosis after endoscopic intervention. The outcomes of 18 studies reporting efficacy of sphincterotomy are shown in Table 6 [3,7,8,26,28,34,37,[46][47][48][49][50][51][52][53]. Follow-up ranged from a mean 3 months to 3.1 years.…”

Section: Managementmentioning

confidence: 99%

The diagnosis and management of Sphincter of Oddi dysfunction: a systematic review

Hall

Dennison

Garcea

2012

Langenbecks Arch Surg

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Non-invasive investigations currently lack sufficient sensitivities and specificities for routine use in diagnosing SOD. Type I SOD should be treated with ES without manometry. Manometry may be useful for Type II SOD. However, whilst data is lacking a therapeutic trial of Botox(TM) or trial stenting may bean alternative. Careful and thorough patient counselling is essential. Type III SOD is associated with high complications from manometry and poor outcomes from ES. Alternative diagnoses should be thoroughly sought and its management should be medical.

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“…It appears logical, but the evidence underlying it is thin and perhaps disappearing [7]. The definitions, as updated later, are as follows.…”

mentioning

confidence: 99%

The patient with pain; suspected gallbladder and sphincter dysfunction

Cotton

2014

Ercp

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Before the days of sophisticated imaging techniques, ERCP was frequently and effectively used to investigate patients with biliary/pancreatic pain and to diagnose and exclude common diseases such as bile duct stones and chronic pancreatitis. The situation is quite different now.Nowadays, most patients with upper abdominal pain have basic laboratory tests taken and undergo upper endoscopy (after careful clinical enquiry and physical examination). If this is negative, abdominal scanning is indicated, by ultrasound in some countries, more likely by computed tomography (CT) in the United States. If that is negative and suspicion persists, MRCP is recommended. These scans provide excellent information about the biliary tree and pancreas, and should also detect problems in surrounding organs, such as aortic aneurysm and renal tumors. This review concerns patients in whom all of these tests are unrevealing.The appropriate next steps are influenced by clinical features, such as age and the type of pain, and any associated complaints, such as weight loss.Epigastric pain, especially if persistent, is suggestive of a pancreatic origin. The best next step is EUS, which can detect small tumors and less severe cases of pancreatitis. EUS is also valuable in looking for small stones in the gallbladder or bile ducts. If EUS is negative, there is no role for ERCP. The chances of finding anything are less than the risk of causing pancreatitis.Intermittent pain in the right upper quadrant (and/or epigastrium) suggests biliary disease, specifically dysfunction of the gallbladder or sphincter of Oddi, and suspicion is enhanced if the liver tests bump with attacks of pain. This is where the algorithm of investigation gets more controversial, since hard data are scarce [1].Gallbladder dysfunction. It is presumed that incoordination of gallbladder emptying can cause pain. Cholescintigraphy (hepatobiliaryiminodiacetic acid,

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Predictors of Outcomes After Biliary and Pancreatic Sphincterotomy for Sphincter of Oddi Dysfunction

Abstract: For the treatment of SOD incorporating pancreatic and biliary sphincterotomy, patient characteristics and pancreatic sphincter manometry may be more important predictors of outcome than the traditional classification based on liver chemistries and bile duct dilation.

Cited by 51 publications

References 51 publications

Sphincter of Oddi dysfunction and pancreatitis

Sphincter of Oddi dysfunction and pancreatitis

The diagnosis and management of Sphincter of Oddi dysfunction: a systematic review

The patient with pain; suspected gallbladder and sphincter dysfunction

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