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Sphinkter-Oddi-Dyskinesie

Sphincter of Oddi dyskinesia

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Zusammenfassung

Die Sphinkter-Oddi-Dyskinesie (SOD) ist eine Funktionsstörung der Papillenregion, die zu klinischen Symptomen und zu einer funktionellen Behinderung des Abflusses von Galle- und Pankreassekret führen kann. Basierend auf der Ausprägung der klinischen Veränderungen und der Erkrankungsschwere wird die SOD in 3 Typen eingeteilt, die biliären oder pankreatischen Typen I–III. Die Existenz und Diagnose der SOD ist nicht ganz unumstritten. Die manometrische Diagnose mithilfe der Sphinkter-Oddi-Manometrie wird durch das relativ hohe Risiko einer Pankreatitis nach endoskopischer retrograder Cholangiopankreatikographie eingeschränkt. Während die Papillenmanometrie in Nordamerika häufiger durchgeführt wird, erfolgt sie in Europa nur in Ausnahmefällen. Manometrisch ist die SOD durch einen erhöhten Druck im Sphinktersegment der Gallenwege und/oder des Pankreas gekennzeichnet. Diese Druckerhöhung kann mit einer endoskopischen Papillotomie gesenkt werden. Kontrovers diskutiert wird, ob primär eine invasive Diagnostik durchgeführt werden sollte oder ob in einem pragmatischen klinischen Ansatz direkt eine Papillotomie durchzuführen ist, wenn der klinische Verdacht auf eine SOD besteht. Für Patienten mit biliärem oder pankreatischem Typ I ist die endoskopische Papillotomie die Therapie der Wahl. Bei Patienten mit einem biliären Typ II kann die Sphinkter-Oddi-Manometrie die Therapieentscheidung erleichtern. Bei Patienten mit Typ III besitzt die Funktionsdiagnostik mit Manometrie nur eine geringe Aussagekraft und hat daher nur einen geringen prädiktiven Wert für den Behandlungserfolg.

Abstract

Sphincter of Oddi dyskinesia is a functional disorder of the papillary region which can lead to clinical symptoms due to functional obstruction of biliary and pancreatic outflow. Based on the severity of the clinical symptoms the disorder can be graded into three types (biliary and pancreatic types I-III). The manometric diagnosis of this disorder using sphincter of Oddi manometry is hampered by the relatively high risk of pancreatitis after endoscopic retrograde cholangiopancreatography. Although papillary manometry is often carried out in North America, in Europe this is the exception rather than the rule. Manometrically, sphincter of Oddi dyskinesia is characterized by an increased pressure in the biliary and/or the pancreatic sphincter segments and can be treated by endoscopic papillotomy. This overview counterbalances the arguments for primary invasive diagnostics and a pragmatic clinical approach, i.e. papillotomy should be directly carried out when a sphincter of Oddi dyskinesia is clinically suspected. For patients with biliary or pancreatic type I, endoscopic papillotomy is the treatment of choice. In biliary type II sphincter of Oddi manometry could be helpful for clinical decision-making; however, the exact risk-benefit ratio is still difficult to assess. In type III patient selection and the low predictive value of manometry for treatment success questions the clinical usefulness of sphincter of Oddi manometry.

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Literatur

  1. Allescher HD (1998) Clinical impact of sphincter of Oddi dyskinesia. Endoscopy 30:A231–A236

    Article  CAS  PubMed  Google Scholar 

  2. Allescher HD, Neuhaus H, Hagenmuller F, Classen M (1990) Effect of N-butylscopolamine on sphincter of Oddi motility in patients during routine ERCP – a manometric study. Endoscopy 22:160–163

    Article  CAS  PubMed  Google Scholar 

  3. Blaut U, Sherman S, Fogel E, Lehman GA (2000) Influence of cholangiography on biliary sphincter of Oddi manometric parameters. Gastrointest Endosc 52:624–629

    Article  CAS  PubMed  Google Scholar 

  4. Botoman VA, Kozarek RA, Novell LA et al (1994) Long-term outcome after endoscopic sphincterotomy in patients with biliary colic and suspected sphincter of Oddi dysfunction. Gastrointest Endosc 40:165–170

    Article  CAS  PubMed  Google Scholar 

  5. Bozkurt T, Orth KH, Butsch B, Lux G (1996) Long-term clinical outcome of post-cholecystectomy patients with biliary-type pain: results of manometry, non-invasive techniques and endoscopic sphincterotomy. Eur J Gastroenterol Hepatol 8:245–249

    Article  CAS  PubMed  Google Scholar 

  6. Brawman-Mintzer O, Durkalski V, Wu Q et al (2014) Psychosocial characteristics and pain burden of patients with suspected sphincter of Oddi dysfunction in the EPISOD multicenter trial. Am J Gastroenterol 109:436–442

    Article  PubMed Central  PubMed  Google Scholar 

  7. Cotton PB, Durkalski V, Romagnuolo J et al (2014) Effect of endoscopic sphincterotomy for suspected sphincter of Oddi dysfunction on pain-related disability following cholecystectomy: the EPISOD randomized clinical trial. JAMA 311:2101–2109

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Dahlöf CGH, Dimenas E (1995) Migraine patients experience poorer subjective well-being/quality of life even between attacks. Cephalalgia 15(1):31–36

    Article  PubMed  Google Scholar 

  9. Darweesh RM, Dodds WJ, Hogan WJ et al (1988) Efficacy of quantitative hepatobiliary scintigraphy and fatty-meal sonography for evaluating patients with suspected partial common duct obstruction. Gastroenterology 94:779–786

    CAS  PubMed  Google Scholar 

  10. Desautels SG, Slivka A, Hutson WR et al (1999) Postcholecystectomy pain syndrome: pathophysiology of abdominal pain in sphincter of Oddi type III. Gastroenterology 116:900–905

    Article  CAS  PubMed  Google Scholar 

  11. Devereaux BM, Sherman S, Lehman GA (2002) Sphincter of Oddi (pancreatic) hypertension and recurrent pancreatitis. Curr Gastroenterol Rep 4:153–159

    Article  PubMed  Google Scholar 

  12. Fullarton GM, Murray WR (1992) Evaluation of endoscopic sphincterotomy in sphincter of Oddi dysfunction. Endoscopy 24:199–202

    Article  CAS  PubMed  Google Scholar 

  13. Geenen JE, Hogan WJ, Dodds WJ et al (1980) Intraluminal pressure recording of the human sphincter of Oddi. Gastroenterology 78:317–324

    CAS  PubMed  Google Scholar 

  14. Geenen JE, Hogan WJ, Dodds WJ et al (1989) The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med 320:82–87

  15. Geenen JE, Toouli J, Hogan WJ et al (1984) Endoscopic sphincterotomy: follow-up evaluation of effects on the sphincter of Oddi. Gastroenterology 87:754–758

    CAS  PubMed  Google Scholar 

  16. Guelrud M, Mendoza S, Rossiter G, Villegas MI (1990) Sphincter of Oddi manometry in healthy volunteers. Dig Dis Sci 35:38–46

    Article  CAS  PubMed  Google Scholar 

  17. Hogan WJ (2000) Sphincter of Oddi dysfunction: the tales of two countries. Curr Gastroenterol Rep 2:91–93

    Article  CAS  PubMed  Google Scholar 

  18. Hogan WJ, Geenen JE (1988) Biliary dyskinesia. Endoscopy 20(Suppl 1):179–183

    Article  PubMed  Google Scholar 

  19. Hogan WJ, Geenen JE, Dodds WJ et al (1982) Paradoxial motor response to cholecystokinin octapeptide (CCK- OP) in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 82:1085

    Google Scholar 

  20. Johnson DA, Cattau EL, Winters C (1986) Biliary dyskinesia with associated high amplitude esophageal peristaltic contractions. Am J Gastroenterol 81:254–256

    CAS  PubMed  Google Scholar 

  21. Kobayashi K, Mitani E, Tatsumi S et al (1985) Studies on papillary function and effect of prifinium bromide and other antispasmodics on motility of the papillary region (sphincter of Oddi) in humans. Clin Ther 7:154–163

    CAS  PubMed  Google Scholar 

  22. Lans JL, Parikh NP, Geenen JE (1991) Application of sphincter of Oddi manometry in routine clinical investigations. Endoscopy 23:139–143

    Article  CAS  PubMed  Google Scholar 

  23. Lasson A (1987) The postcholecystektomy syndrome: diagnostic and therapeutic strategy. Scand J Gastroenterol 22:897–902

    Article  CAS  PubMed  Google Scholar 

  24. Lasson A (1988) The postcholecystectomy syndrome: bile ducts as pain trigger zone. Scand J Gastroenterol 23:265–271

    Article  CAS  PubMed  Google Scholar 

  25. Madacsy L, Velosy B, Lonovics J, Csernay L (1995) Evaluation of results of the prostigmine-morphine test with quantitative hepatobiliary scintigraphy: a new method for the diagnosis of sphincter of Oddi dyskinesia. Eur J Nucl Med 22:227–232

    Article  CAS  PubMed  Google Scholar 

  26. Mariani A, Curioni S, Zanello A et al (2003) Secretin MRCP and endoscopic pancreatic manometry in the evaluation of sphincter of Oddi function: a comparative pilot study in patients with idiopathic recurrent pancreatitis. Gastrointest Endosc 58:847–852

    Article  PubMed  Google Scholar 

  27. Meshkinpour H, Mollot M (1992) Sphincter of Oddi dysfunction and unexplained abdominal pain: clinical and manometric study. Dig Dis Sci 37:257–261

    Article  CAS  PubMed  Google Scholar 

  28. Meshkinpour H, Mollot M, Eckerling GB, Bookman L (1984) Bile duct dyskinesia: clinical and manometric study. Gastroenterology 87:759–762

    CAS  PubMed  Google Scholar 

  29. Mosko JD, Chuttani R (2014) EPISOD puts an end to sphincter of Oddi dysfunction type III. Ann Gastroenterol 27:427–428

    PubMed Central  PubMed  Google Scholar 

  30. Raddawi HM, Geenen JE, Hogan WJ et al (1991) Pressure measurements from biliary and pancreatic segments of sphincter of Oddi. Comparison between patients with functional abdominal pain, biliary, or pancreatic disease. Dig Dis Sci 36:71–74

    Article  CAS  PubMed  Google Scholar 

  31. Rolny P (1997) Endoscopic bile duct stent placement as a predictor of outcome following endoscopic sphincterotomy in patients with suspected sphincter of Oddi dysfunction. Eur J Gastroenterol Hepatol 9:467–471

    Article  CAS  PubMed  Google Scholar 

  32. Rolny P, Arleback A (1993) Effect of midazolam on sphincter of Oddi motility. Endoscopy 25:381–383

    Article  CAS  PubMed  Google Scholar 

  33. Rolny P, Arleback A, Funch-Jensen P et al (1986) Paradoxical response of sphincter of Oddi to intravenous injection of cholecystokinin or ceruletide. Manometric findings and results of treatment in biliary dyskinesia. Gut 27:1507–1511

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Rolny P, Arleback A, Jarnerot G, Andersson T (1986) Endoscopic manometry of the sphincter of Oddi and pancreatic duct in chronic pancreatitis. Scand J Gastroenterol 21:415–420

    Article  CAS  PubMed  Google Scholar 

  35. Rolny P, Geenen JE, Hogan WJ (1993) Post-cholecystectomy patients with „objective signs“ of partial bile outflow obstruction: clinical characteristics, sphincter of Oddi manometry findings, and results of therapy. Gastrointest Endosc 39:778–781

    Article  CAS  PubMed  Google Scholar 

  36. Romagnuolo J, Cotton PB, Durkalski V et al (2014) Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction? Gastrointest Endosc 79:765–772

    Article  PubMed Central  PubMed  Google Scholar 

  37. Schmalz MJ, Geenen JE, Hogan WJ et al (1990) Pain on common bile duct injection during ERCP: does it indicate sphincter of Oddi dysfunction? Gastrointest Endosc 36:458–461

    Article  CAS  PubMed  Google Scholar 

  38. Steinberg WM (1988) Sphincter of Oddi dysfunction: a clinical controversy. Gastroenterology 95:1409–1415

    CAS  PubMed  Google Scholar 

  39. Tarnasky P, Cunningham J, Cotton P et al (1997) Pancreatic sphincter hypertension increases the risk of post-ERCP pancreatitis. Endoscopy 29:252–257

    Article  CAS  PubMed  Google Scholar 

  40. Tarnasky PR, Hoffman B, Aabakken L et al (1997) Sphincter of Oddi dysfunction is associated with chronic pancreatitis. Am J Gastroenterol 92:1125–1129

    CAS  PubMed  Google Scholar 

  41. Thune A, Scicchitano J, Roberts-Thomson I, Toouli J (1991) Reproducibility of endoscopic sphincter of Oddi manometry. Dig Dis Sci 36:1401–1405

    Article  CAS  PubMed  Google Scholar 

  42. Toouli J (1984) Sphincter of Oddi motility. Br J Surg 71:251–256

    Article  CAS  PubMed  Google Scholar 

  43. Toouli J (2002) Biliary dyskinesia. Curr Treat Options Gastroenterol 5:285–291

    Article  PubMed  Google Scholar 

  44. Toouli J, Roberts-Thomson IC, Dent J, Lee J (1985) Manometric disorders in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 88:1243–1250

    CAS  PubMed  Google Scholar 

  45. Toouli J, Roberts-Thomson IC, Kellow J et al (2000) Manometry based randomised trial of endoscopic sphincterotomy for sphincter of Oddi dysfunction. Gut 46:98–102

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Utsunomiya N, Tanaka M, Ogawa Y et al (2000) Pain associated with phase III of the duodenal migrating motor complex in patients with postcholecystectomy biliary dyskinesia. Gastrointest Endosc 51:528–534

    Article  CAS  PubMed  Google Scholar 

  47. Venu RP, Geenen JE, Hogan W et al (1989) Idiopathic recurrent pancreatitis. An approach to diagnosis and treatment. Dig Dis Sci 34:56–60

    Article  CAS  PubMed  Google Scholar 

  48. Wehrmann T, Aharonoff H, Dietrich CF et al (1997) Do ultrasound parameters allow diagnosis of biliary sphincter of Oddi dysfunction? Z Gastroenterol 35:449–457

  49. Wehrmann T, Schmitt TH, Arndt A et al (2000) Endoscopic injection of botulinum toxin in patients with recurrent acute pancreatitis due to pancreatic sphincter of Oddi dysfunction. Aliment Pharmacol Ther 14:1469–1477

    Article  CAS  PubMed  Google Scholar 

  50. Wehrmann T, Seifert H, Seipp M et al (1998) Endoscopic injection of botulinum toxin for biliary sphincter of Oddi dysfunction. Endoscopy 30:702–707

    Article  CAS  PubMed  Google Scholar 

  51. Wehrmann T, Wiemer K, Lembcke B et al (1996) Do patients with sphincter of Oddi dysfunction benefit from endoscopic sphincterotomy? A 5-year prospective trial. Eur J Gastroenterol Hepatol 8:251–256

    Article  CAS  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. H.-D. Allescher gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Zentrum Innere Medizin, Klinikum Garmisch-Partenkirchen, Auenstr. 6, 86472, Garmisch-Partenkirchen, Deutschland

    H.-D. Allescher

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Allescher, HD. Sphinkter-Oddi-Dyskinesie. Internist 56, 638–647 (2015). https://doi.org/10.1007/s00108-014-3605-8

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