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Sphincter of oddi dysfunction in children

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Abstract

Sphincter of Oddi dysfunction (SOD) is a clinical entity caused by a primary motility alteration of either the biliary or the pancreatic sphincter. SOD is a rare condition that has been scarcely reported in children. Most of the reported literature has been in children with idiopathic recurrent pancreatitis. These children are treated endoscopically by dual sphincterotomy of the pancreatic and common duct sphincters. However, the safety and efficacy of sphincter of Oddi manometry and sphincterotomy in the pediatric population await further study.

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References and Recommended Reading

  1. Behar JCE, Guelrud M, Hogan W, et al.: Functional disorders of gallbladder and sphincter of Oddi. Gastroenterology, in press. This ROME III review summarizes the different aspects of SOD and proposes a clinical approach to the diagnosis and treatment of these patients.

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  4. Frates RE: Incompetence of the sphincter of Oddi in the newborn. Radiology 1965, 85:875–879.

    PubMed  CAS  Google Scholar 

  5. Lin OS, Soetikno RM, Young HS: The utility of liver function test abnormalities concomitant with biliary symptoms in predicting a favorable response to endoscopic sphincterotomy in patients with presumed sphincter of Oddi dysfunction. Am J Gastroenterol 1998, 93:1833–1836.

    Article  PubMed  CAS  Google Scholar 

  6. Barish MA, Yucel EK, Ferrucci JT: Magnetic resonance cholangiopancreatography. N Engl J Med 1999, 341:258–264.

    Article  PubMed  CAS  Google Scholar 

  7. Mariani A, Curioni S, Zanello A, et al.: 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 2003, 58:847–852.

    Article  PubMed  Google Scholar 

  8. Di Francesco V, Brunori MP, Rigo L, et al.: Comparison of ultrasound-secretin test and sphincter of Oddi manometry in patients with recurrent acute pancreatitis. Dig Dis Sci 1999, 44:336–340.

    Article  PubMed  Google Scholar 

  9. Catalano MF, Lahoti S, Alcocer E, et al.: Dynamic imaging of the pancreas using real-time endoscopic ultrasonography with secretin stimulation. Gastrointest Endosc 1998, 48:580–587.

    Article  PubMed  CAS  Google Scholar 

  10. Bar-Meir S, Chamovitz D: 99mTc-DISIDA vs. endoscopic biliary manometry in assessing sphincter of Oddi function. Hepatology 1989, 10:895–896.

    Article  PubMed  CAS  Google Scholar 

  11. Corazziari E, Cicala M, Habib FI, et al.: Hepatoduodenal bile transit in cholecystectomized subjects. Relationship with sphincter of Oddi function and diagnostic value. Dig Dis Sci 1994, 39:1985–1993.

    Article  PubMed  CAS  Google Scholar 

  12. Muehldorfer SM, Hahn EG, Ell C: Botulinum toxin injection as a diagnostic tool for verification of sphincter of Oddi dysfunction causing recurrent pancreatitis. Endoscopy 1997, 29:120–124.

    PubMed  CAS  Google Scholar 

  13. Guelrud M, Mendoza S, Rossiter G, et al.: Sphincter of Oddi manometry in healthy volunteers. Dig Dis Sci 1990, 35:38–46.

    Article  PubMed  CAS  Google Scholar 

  14. Bergman JJ, van Berkel AM, Groen AK, et al.: Biliary manometry, bacterial characteristics, bile composition, and histologic changes fifteen to seventeen years after endoscopic sphincterotomy. Gastrointest Endosc 1997, 45:400–405.

    Article  PubMed  CAS  Google Scholar 

  15. Nahon Uzan K, Levy P, O’Toole D, et al.: Is idiopathic chronic pancreatitis an autoimmune disease? Clin Gastroenterol Hepatol 2005, 3:903–909. This study provides a good review of autoimmune pancreatitis and proposes a classification of this entity.

    Article  PubMed  Google Scholar 

  16. Cohn JA, Friedman KJ, Noone PG, et al.: Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis. N Engl J Med 1998, 339:653–658.

    Article  PubMed  CAS  Google Scholar 

  17. Chen JM, Piepoli Bis A, Le Bodic L, et al.: Mutational screening of the cationic trypsinogen gene in a large cohort of subjects with idiopathic chronic pancreatitis. Clin Genet 2001, 59:189–193.

    Article  PubMed  CAS  Google Scholar 

  18. Sharer N, Schwarz M, Malone G, et al.: Mutations of the cystic fibrosis gene in patients with chronic pancreatitis. N Engl J Med 1998, 339:645–652.

    Article  PubMed  CAS  Google Scholar 

  19. Yoshida K, Toki F, Takeuchi T, et al.: Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 1995, 40:1561–1568.

    Article  PubMed  CAS  Google Scholar 

  20. Guelrud MC-LD, Fox VL: ERCP in Pediatric Practice: Diagnosis and Treatment. Oxford, UK: Isis Medical Media Ltd.: 1997.

    Google Scholar 

  21. Coyle WJ, Pineau BC, Tarnasky PR, et al.: Evaluation of unexplained acute and acute recurrent pancreatitis using endoscopic retrograde cholangiopancreatography, sphincter of Oddi manometry and endoscopic ultrasound. Endoscopy 2002, 34:617–623. In a group of patients with unexplained pancreatitis, a cause was identified in the majority. SOD represented the most common finding (31%). The authors showed that bile analysis, SOM, and EUS are useful tools in the evaluation of unexplained acute pancreatitis.

    Article  PubMed  CAS  Google Scholar 

  22. Brown CW, Werlin SL, Geenen JE, et al.: The diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography in children. J Pediatr Gastroenterol Nutr 1993, 17:19–23.

    Article  PubMed  CAS  Google Scholar 

  23. Hsu RK, Draganov P, Leung JW, et al.: Therapeutic ERCP in the management of pancreatitis in children. Gastrointest Endosc 2000, 51:396–400.

    Article  PubMed  CAS  Google Scholar 

  24. Lemmel THR, Sherman S, Lehman G: Endoscopic evaluation and therapy of recurrent pancreatitis and pancreaticobiliary pain in the pediatric population. Gastrointest Endosc 1994, 40:A54.

    Google Scholar 

  25. Guelrud M, Mujica C, Jaen D, et al.: The role of ERCP in the diagnosis and treatment of idiopathic recurrent pancreatitis in children and adolescents. Gastrointest Endosc 1994, 40:428–436.

    Article  PubMed  CAS  Google Scholar 

  26. Raddawi HM, Geenen JE, Hogan WJ, et al.: 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 1991, 36:71–74.

    Article  PubMed  CAS  Google Scholar 

  27. Guelrud M, Siegel JH: Hypertensive pancreatic duct sphincter as a cause of pancreatitis. Successful treatment with hydrostatic balloon dilatation. Dig Dis Sci 1984, 29:225–231.

    Article  PubMed  CAS  Google Scholar 

  28. Tarnasky PR, Palesch YY, Cunningham JT, et al.: Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology 1998, 115:1518–1524.

    Article  PubMed  CAS  Google Scholar 

  29. Fogel EL, Eversman D, Jamidar P, et al.: Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone. Endoscopy 2002, 34:280–285. This study in SOD patients demonstrated that post-ERCP pancreatitis has improved with the addition of a pancreatic stent placement with combined pancreaticobiliary sphincter therapy.

    Article  PubMed  CAS  Google Scholar 

  30. Shimotake T, Iwai N, Yanagihara J, et al.: Biliary tract complications in patients with hypoganglionosis and chronic idiopathic intestinal pseudoobstruction syndrome. J Pediatr Surg 1993, 28:189–192.

    Article  PubMed  CAS  Google Scholar 

  31. Heitlinger LA, McClung HJ, Murray RD, et al.: Recurrent pancreatitis in three patients with chronic idiopathic intestinal pseudo-obstruction. J Pediatr Gastroenterol Nutr 1991, 13:92–95.

    Article  PubMed  CAS  Google Scholar 

  32. Koussayer T, Ducker TE, Clench MH, et al.: Ampulla of Vater/duodenal wall spasm diagnosed by antroduodenal manometry. Dig Dis Sci 1995, 40:1710–1719.

    Article  PubMed  CAS  Google Scholar 

  33. Soffer EE, Johlin FC: Intestinal dysmotility in patients with sphincter of Oddi dysfunction. A reason for failed response to sphincterotomy. Dig Dis Sci 1994, 39:1942–1946.

    Article  PubMed  CAS  Google Scholar 

  34. Evans PR, Bak YT, Dowsett JF, et al.: Small bowel dysmotility in patients with postcholecystectomy sphincter of Oddi dysfunction. Dig Dis Sci 1997, 42:1507–1512.

    Article  PubMed  CAS  Google Scholar 

  35. Binmoeller KF, Dumas R, Harris AG, et al.: Effect of somatostatin analog octreotide on human sphincter of Oddi. Dig Dis Sci 1992, 37:773–777.

    Article  PubMed  CAS  Google Scholar 

  36. Bodemar G, Hjortswang H: Octreotide-induced pancreatitis: an effect of increased contractility of Oddi sphincter. Lancet 1996, 348:1668–1669.

    Article  PubMed  CAS  Google Scholar 

  37. Gollin G, Raschbaum GR, Moorthy C, et al.: Cholecystectomy for suspected biliary dyskinesia in children with chronic abdominal pain. J Pediatr Surg 1999, 34:854–857.

    Article  PubMed  CAS  Google Scholar 

  38. Campbell BT, Narasimhan NP, Golladay ES, et al.: Biliary dyskinesia: a potentially unrecognized cause of abdominal pain in children. Pediatr Surg Int 2004, 20:579–581.

    Article  PubMed  Google Scholar 

  39. Kimura K, Ohto M, Ono T, et al.: Congenital cystic dilatation of the common bile duct: relationship to anomalous pancreaticobiliary ductal union. AJR Am J Roentgenol 1977, 128:571–577.

    PubMed  CAS  Google Scholar 

  40. Oguchi Y, Okada A, Nakamura T, et al.: Histopathologic studies of congenital dilatation of the bile duct as related to an anomalous junction of the pancreaticobiliary ductal system: clinical and experimental studies. Surgery 1988, 103:168–173.

    PubMed  CAS  Google Scholar 

  41. Guelrud M, Morera C, Rodriguez M, et al.: Sphincter of Oddi dysfunction in children with recurrent pancreatitis and anomalous pancreaticobiliary union: an etiologic concept. Gastrointest Endosc 1999, 50:194–199.

    Article  PubMed  CAS  Google Scholar 

  42. Tanaka M, Ikeda S, Kawakami K, et al.: The presence of a positive pressure gradient from pancreatic duct to choledochal cyst demonstrated by duodenoscopic microtransducer manometry: clue to pancreaticobiliary reflux. Endoscopy 1982, 14:45–47.

    PubMed  CAS  Google Scholar 

  43. Davenport M, Basu R: Under pressure: choledochal malformation manometry. J Pediatr Surg 2005, 40:331–335.

    Article  PubMed  Google Scholar 

  44. Babbitt DP: [Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb]. Ann Radiol 1969, 12:231–240.

    PubMed  CAS  Google Scholar 

  45. Brown KO, Goldschmiedt M: Endoscopic therapy of biliary and pancreatic disorders in children. Endoscopy 1994, 26:719–723.

    PubMed  CAS  Google Scholar 

  46. Buckley A, Connon JJ: The role of ERCP in children and adolescents. Gastrointest Endosc 1990, 36:369–372.

    PubMed  CAS  Google Scholar 

  47. Cotton PB, Laage NJ: Endoscopic retrograde cholangiopancreatography in children. Arch Dis Child 1982, 57:131–136.

    PubMed  CAS  Google Scholar 

  48. Dite P, Vacek E, Stefan H, et al.: Endoscopic retrograde cholangiopancreatography in childhood. Hepatogastroenterology 1992, 39:291–293.

    PubMed  CAS  Google Scholar 

  49. Putnam PE, Kocoshis SA, Orenstein SR, et al.: Pediatric endoscopic retrograde cholangiopancreatography. Am J Gastroenterol 1991, 86:824–830.

    PubMed  CAS  Google Scholar 

  50. Forbes A, Leung JW, Cotton PB: Relapsing acute and chronic pancreatitis. Arch Dis Child 1984, 59:927–934.

    PubMed  CAS  Google Scholar 

  51. Misra SP, Dwivedi M: Pancreaticobiliary ductal union. Gut 1990, 31:1144–1149.

    PubMed  CAS  Google Scholar 

  52. Mori K, Nagakawa T, Ohta T, et al.: Pancreatitis and anomalous union of the pancreaticobiliary ductal system in childhood. J Pediatr Surg 1993, 28:67–71.

    Article  PubMed  CAS  Google Scholar 

  53. Greene FL, Brown JJ, Rubinstein P, et al.: Choledochocele and recurrent pancreatitis. Diagnosis and surgical management. Am J Surg 1985, 149:306–309.

    Article  PubMed  CAS  Google Scholar 

  54. Siegel JH, Harding GT, Chateau F: Endoscopic incision of choledochal cysts (choledochocele). Endoscopy 1981, 13:200–202.

    Article  PubMed  CAS  Google Scholar 

  55. Kagiyama S, Okazaki K, Yamamoto Y: Anatomic variants of choledochocele and manometric measurements of pressure in the cele and the orifice zone. Am J Gastroenterol 1987, 82:641–649.

    PubMed  CAS  Google Scholar 

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Correspondence to Moises Guelrud MD.

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Guelrud, M., Rodriguez, L. Sphincter of oddi dysfunction in children. Curr Gastroenterol Rep 8, 168–171 (2006). https://doi.org/10.1007/s11894-006-0014-8

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