Abstract
Sphincter of Oddi dysfunction (SOD) is associated with abdominal pain and is treated by sphincterotomy. Of 215 patients who underwent biliary sphincterotomy for SOD in our institution, 26 reported no improvement and 25 of those were found to have pancreatic sphincter dysfunction and subsequently underwent pancreatic septotomy. Nine patients remained symptomatic after the second intervention. Six of those nine patients, and seven of the 16 patients who improved after the septotomy, agreed to undergo an ambulatory duodenojejunal (DJ) manometry. DJ manometry was abnormal in four of the six symptomatic patients but only in one of seven patients who became asymptomatic after endoscopic treatment. We conclude that the persistence of symptoms after endoscopic ablation of the biliary and pancreatic sphincters is associated with abnormal intestinal motility, which may explain in part the lack of response to the endoscopic treatment.
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Guelrud M, Mendoza S, Rossiter G, Villegas MI: Sphincter of Oddi manometry in healthy volunteers. Dig Dis Sci 35:38–46, 1990
Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Veru RP: The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med 320:82–87, 1989
Aronchick CA, Long WB, Soloway RD: Endoscopic biliary manometry and a modified morphine prostigmine test as predictors of clinical response to sphincterotomy in biliary dyskinesia. Gastrointest Endosc 30:140, 1984
Neoptolemos JP, Bailey IS, Carr-Locke DL: Sphincter of Oddi dysfunction: Results of treatment by endoscopic sphincterotomy. Br J Surg 75:454–459, 1988
Roberts-Thomson IC, Toouli J: Is endoscopic sphincterotomy for disabling biliary type pain after cholecystectomy effective? Gastrointest Endosc 31:370–373, 1985
Thatcher BS, Sivak MV, Tedesco FJ, Vennes JA, Hutton SW, Achkar EA: Endoscopic sphincterotomy for suspected dysfunction of the sphincter of Oddi. Gastrointest Endosc 33:91–95, 1987
Summers RW, Johlin FC: The pathophysiology, evaluation and management of motility disorders of the biliary tract. Gastroenterol Clin North Am 18:425–435, 1989
Soffer EE, Summers RW: Ambulant manometry.In An Illustrated Guide to Gastrointestinal Motility, 2nd ed. D Kumar, DL Wingate (eds). London, Churchill-Livingstone, 1993, pp 200–211
Botoman VA, Kozarek RA, Novell LA, Patterson DJ, Ball TJ, Gelfand MD, Neal LA: Gastroparesis in patients with unexplained biliary colic and suspected sphincter of Oddi dysfunction. Gastroenterology 102:A303, 1992
Johnson DA, Cattau EL Jr, Winters C Jr: Biliary dyskinesia with associated high amplitude esophageal peristaltic contractions. Am J Gastroenterol 81:254–256, 1986
Wood JD: Physiology of the enteric nervous system.In Physiology of the Gastrointestinal Tract. LR Johnson (ed). New York, Raven Press, 1987, pp 67–109
Hogan WJ, Geenen J, Dodds WJ, Toouli J, Venu R, Helm J: Paradoxical motor response to cholecystokinin (CCK-OP) in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 82:1085, 1982
Rolny P, Arleback A, Funch-Jensen P, Kruse A, Ravnsbaeck J, Järnerot G: Paradoxical response of sphincter of Oddi to IV injection of cholecystokinin or ceruletide. Manometric findings and results of treatment in biliary dyskinesia. Gut 27:1507–1511, 1986
Behar J, Biancani P: The effect of cholecystokinin and the octapeptide of cholecystokinin on the feline sphincter of Oddi and gallbladder: Mechanisms of action. J Clin Invest 66:1231–1239, 1980
Toouli J, Hogan WJ, Geenen JE, Dodds WJ, Arndorfer RC: Action of cholecystokinin-octapeptide on sphincter of Oddi basal pressure and phasic wave activity in humans. Surgery 92:497–503, 1982
Dodds WJ, Dent J, Hogan WJ, Patel GK, Toouli J, Arndorfer RC: Paradoxical lower esophageal sphincter contraction induced by cholecystokinin-octapeptide in patients with achalasia. Gastroenterology 80:327–333, 1981
Kozarek RA: Biliary dyskinesia. Are we any closer to defining the entity? Gastrointest Endosc Clin North Am 3:167–178, 1993
Troiano F, O'Connor K, Sherman S: Psychological sphincter of Oddi dysfunction patients. Am J Gastroenterol 85:1261A, 1990
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Soffer, E.E., Johlin, F.C. Intestinal dysmotility in patients with sphincter of oddi dysfunction. Digest Dis Sci 39, 1942–1946 (1994). https://doi.org/10.1007/BF02088129
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DOI: https://doi.org/10.1007/BF02088129