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

Abstract

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.

Surgical ampullectomy: an underestimated operation in the era of endoscopy

“…2 This is suitable for all benign pathologies including pancreatic sphincter dysfunction, symptomatic pancreas divisum without signs of chronic pancreatitis and small benign neoplastic lesions. 14,15 However, endoscopic approaches are limited in case of recurrence of inflammatory disease with sclerosis of the pancreatic sphincter or when a neoplastic lesion exceeds the size that allows safe endoscopic removal. 15 In these situations, TSA is a feasible approach avoiding pancreatic head resection.…”

Sphincter of Oddi Dysfunction

“…69,70 Others have advocated for sphincter botulinum injection or transpapillary stenting as a therapeutic trial before committing patients to a sphincterotomy. 71,72 If the decision is made to offer endoscopic treatment after exhausting optimal medical therapy, a candid discussion about the risks and benefits of ERCP for this indication is mandatory. The endoscopist should emphasize that although the risk of post-ERCP pancreatitis can be reduced with the use of rectal indomethacin and prophylactic pancreatic duct stenting (both of which are highly recommended in this population), this risk remains substantial, especially when compared with potentially ineffective therapy.…”

Endoscopic Treatment of Pancreatic Diseases

“…Prophylactic pancreatic stenting for two weeks after sphincterotomy has shown to reduce the incidence of post-ERCP pancreatitis [75]. Clinical improvement after sphincterotomy has been reported in 55%-95% of patients, depending on the type of SOD, and manometric recordings [76,77]. The analyses of published studies (237 patients with follow-up ranging from a mean of 3 months to 5 years) showed that favorable outcomes are the highest in type I SOD cases (83%-100%) while in type II SOD patients long-term symptom relief was reported in up to 79%, depending on whether manometry was abnormal.…”