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Postcholecystectomy Pain

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Essential Medical Disorders of the Stomach and Small Intestine

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Abstract

Postcholecystectomy pain, even when typically biliary-like, may develop from many different conditions although it more frequently originates from esophagogastroduodenal and pancreatic disorders and irritable bowel syndrome (IBS). In the absence of structural abnormalities, and after excluding functional dyspepsia and IBS, the pain may be caused by sphincter of Oddi dysfunction and/or a condition of hyperalgesia of the biliary tract. Additionally, it may originate from adjacent organs sharing the same afferent innervations. A specific algorithm is provided to diagnose the sensory-motor dysfunction that characterizes postcholecystectomy pain and to minimize invasive procedures, with the goal of avoiding the high risk of pancreatitis following endoscopic maneuvers.

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References

  1. Pucher PH, Brunt LM, Davies N, et al., SAGES Safe Cholecystectomy Task Force. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc. 2018;32:2175–83.

    Google Scholar 

  2. Lamberts MP, Lugtenberg M, Rovers MM, et al. Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surg Endosc. 2012;27:709–18.

    Article  Google Scholar 

  3. Corazziari E, Attili AF, Angeletti C, et al. A. Gallstones, cholecystectomy and irritable bowel syndrome (IBS) MICOL population-based study. Dig Liver Dis. 2008;40:944–50.

    Article  CAS  Google Scholar 

  4. Cotton PB, Pauls Q, Keith J, et al. The EPISOD study: long-term outcomes. Gastrointest Endosc. 2018;87:205–10.

    Article  Google Scholar 

  5. Cotton PB, Elta GH, Carter CR, et al. Gallbladder and sphincter of Oddi disorders. Gastroenterology. 2016;150:1420–9.

    Article  Google Scholar 

  6. Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, socio-demographic and health impact. Dig Dis Sci. 1993;38:1569–80.

    Article  CAS  Google Scholar 

  7. Doran FS. The sites to which pain is referred from the common bile-duct in man and its implication for the theory of referred pain. Br J Surg. 1967;54:599–606.

    Article  CAS  Google Scholar 

  8. Luman W, Williams AJ, Pryde A, et al. Influence of cholecystectomy on sphincter of Oddi motility. Gut. 1997;41:371–4.

    Article  CAS  Google Scholar 

  9. Desautels SG, Slivka A, Hutson WR, et al. Postcholecystectomy pain syndrome: pathophysiology of abdominal pain in sphincter of Oddi type III. Gastroenterology. 1999;116:900–5.

    Article  CAS  Google Scholar 

  10. Leung WD, Sherman S. Endoscopic approach to the patient with motility disorders of the bile duct and sphincter of Oddi. Gastrointest Endosc Clin N Am. 2013;23:405–34.

    Article  Google Scholar 

  11. Tarnasky PR. Post-cholecystectomy syndrome and sphincter of Oddi dysfunction: past, present and future. Expert Rev Gastroenterol Hepatol. 2016;10:1359–72.

    Article  CAS  Google Scholar 

  12. Corazziari E, Cicala M, Scopinaro F, et al. Scintigraphic assessment of SO dysfunction. Gut. 2003;52:1655–6.

    Article  CAS  Google Scholar 

  13. 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;39:1985–93.

    Article  CAS  Google Scholar 

  14. Cicala M, Habib FI, Vavassori P, et al. Outcome of endoscopic sphincterotomy in post cholecystectomy patients with sphincter of Oddi dysfunction as predicted by manometry and quantitative choledochoscintigraphy. Gut. 2002;50:665–8.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  16. Pauls Q, Durkalski-Mauldin V, Brawman-Mintzer O, et al. Duloxetine for the treatment of patients with suspected sphincter of Oddi dysfunction: a pilot study. Dig Dis Sci. 2016;61:2704–9.

    Article  CAS  Google Scholar 

  17. Vitton V, Delpy R, Gasmi M, et al. Is endoscopic sphincterotomy avoidable in patients with sphincter of Oddi dysfunction? Eur J Gastroenterol Hepatol. 2008;20:15–21.

    Article  Google Scholar 

  18. Kalaitzakis E, Ambrose T, Phillips-Hughes J, et al. Management of patients with biliary sphincter of Oddi disorder without sphincter of Oddi manometry. BMC Gastroenterol. 2010;10:124.

    Article  Google Scholar 

  19. Viceconte G, Viceconte GW, Pietropaolo V, et al. Endoscopic sphincterotomy: indications and results. Br J Surg. 1981;68:376–80.

    Article  CAS  Google Scholar 

  20. Thatcher BS, Sivak MV, Tedesco FJ, et al. Endoscopic sphincterotomy for suspected dysfunction of the sphincter of Oddi. Gastrointest Endosc. 1987;33:91–5. 101.

    Article  CAS  Google Scholar 

  21. Petersen BT. An evidence-based review of sphincter of Oddi dysfunction: part I, presentations with “objective” biliary findings (types I and II). Gastrointest Endosc. 2004;59:525–34.

    Article  Google Scholar 

  22. 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;320:82–7.

    Article  CAS  Google Scholar 

  23. 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;93:1833–6.

    Article  CAS  Google Scholar 

  24. Freeman ML, Gill M, Overby C, et al. Predictors of outcomes after biliary and pancreatic sphincterotomy for sphincter of oddi dysfunction. J Clin Gastroenterol. 2007;41:94–102.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, Clinical Institute Humanitas, Rozzano, Italy

    Enrico Stefano Corazziari

  2. Department of Internal Medicine and Medical Specialties, Department of Gastroenterology A, University La Sapienza, Rome, Italy

    Nadia Pallotta

Authors
  1. Enrico Stefano Corazziari
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  2. Nadia Pallotta
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Corresponding author

Correspondence to Enrico Stefano Corazziari .

Editor information

Editors and Affiliations

  1. Mayo Clinic, Jacksonville, FL, USA

    Brian E. Lacy

  2. Mayo Clinic, Scottsdale, AZ, USA

    John K. DiBaise

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Mark Pimentel

  4. Leeds Teaching Hospitals NHS Trust, Leeds Gastroenterology Institute, Leeds, UK

    Alexander C. Ford

Self-Test

Self-Test

  • Question 1. Which one of the following answers (A–D) most accurately completes the following statement?

    Biliary pain builds up to a steady level, lasts 30 min or longer, and:

    1. A.

      Is located in the right upper quadrant

    2. B.

      Is similar to the pain triggered by distension of the esophagus

    3. C.

      Radiates to the back in almost all cases

    4. D.

      Mainly occurs after eating a fatty meal

  • Question 2. After cholecystectomy, in the absence of structural pathology of the biliary tract and/or sphincter of Oddi, the pathophysiological mechanism(s) leading to biliary pain relies mainly on which one of the following:

    1. A.

      Increased resistance to bile outflow and subsequent rise in intrabiliary pressure

    2. B.

      Loss of the physiological cholecysto-sphincteric reflex

    3. C.

      Paradoxical response to cholecystokinin after cholecystectomy

    4. D.

      Complex interaction among altered innervation of the SO, persistent activation of nociceptive neurons, and cross-sensitization with neighboring organs

  • Question 3. The term “suspected” SO dysfunction (SOD) should be used for patients with which one of the following:

    1. A.

      Postcholecystectomy biliary pain and one of the objective findings of bile flow obstruction

    2. B.

      Postcholecystectomy biliary pain in the absence of structural pathology of the biliary tract as assessed by EUS

    3. C.

      Postcholecystectomy biliary pain and at least two objective findings of bile flow obstruction

    4. D.

      Postcholecystectomy biliary pain and objective findings of abnormal SO manometry and/or hepatobiliary scintigraphy

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Corazziari, E.S., Pallotta, N. (2019). Postcholecystectomy Pain. In: Lacy, B., DiBaise, J., Pimentel, M., Ford, A. (eds) Essential Medical Disorders of the Stomach and Small Intestine. Springer, Cham. https://doi.org/10.1007/978-3-030-01117-8_14

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  • DOI: https://doi.org/10.1007/978-3-030-01117-8_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-01116-1

  • Online ISBN: 978-3-030-01117-8

  • eBook Packages: MedicineMedicine (R0)

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