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Sphincter of Oddi Dysfunction After Successful Gallstone Lithotripsy (Postlithotripsy Syndrome) Manometric Data and Results of Endoscopic Sphincterotomy

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Abstract

After successful gallstone lithotripsy, biliarypain recurs in about one third of patients. However,gallstone recurrence can be shown in only 40-60% ofthese patients. Therefore, other causes, such as sphincter of Oddi dysfunction (SOD), may besuspected. Twenty-two consecutive patients withrecurrent biliary pain after successful gallstonelithotripsy without evidence of gallstone recurrence atultrasonography were enrolled. Liver tests were elevated in 13patients and ERC showed a dilated bile duct in nine. All22 patients underwent sphincter of Oddi (SO) manometry,bile sample analysis for microlithiasis, endoscopic sphincterotomy (ES), and bile duct explorationwith a Dormia basket. Thereafter, the patients wereclinically followed at bimonthly intervals. SO manometryrevealed SOD in 15/22 patients. This was more often the case in patients with initiallylarger (>2 cm) or multiple stones than afterlithotripsy for solitary small stones (P < 0.01).Microlithiasis was detected in one patient, anotherpatient had small biliary calculi at bile ductexploration (both without SOD). After ES, 14/15 patientswith biliary SOD but none of the five without SODimproved (median follow-up: two years; P < 0.01). The one patient with CBD stones became symptom-freeafter ES, while the patient with microlithiasis improvedafter additional cholecystectomy only. Overall, ESproved to be the adequate therapy in 15/22 patients (68%, median follow-up: 22 months). Aftergallstone lithotripsy, SOD is found in about two thirdsof patients with recurrent symptoms but withoutgallstone recurrence. In this group CBD stones ormicrolithiasis are rare. Therefore, SOD has to be suspected inthis situation and ES gives favorable results, even whenperformed on a clinical basis only (without SOmanometry).

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Authors
  1. Till Wehrmann
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  2. Bernhard Lembcke
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  3. Wolfgang F. Caspary
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  4. Hans Seifert
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Wehrmann, T., Lembcke, B., Caspary, W.F. et al. Sphincter of Oddi Dysfunction After Successful Gallstone Lithotripsy (Postlithotripsy Syndrome) Manometric Data and Results of Endoscopic Sphincterotomy. Dig Dis Sci 44, 2244–2250 (1999). https://doi.org/10.1023/A:1026652619959

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