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The diagnosis and management of Sphincter of Oddi dysfunction: a systematic review.

Abstract

OBJECTIVES
Sphincter of Oddi dysfunction (SOD) is a benign pathological syndrome. The clinical manifestations may be a consequence of an anatomical stenosis or sphincter dysmotility. Manometry is invasive and has an associated morbidity. Non-invasive investigations have been evaluated to ameliorate risk but have unknown efficacy. The review aims to critically appraise current evidence for the diagnosis and management of SOD.
METHODS
A systematic review of articles containing relevant search terms was performed.
RESULTS
Manometry is the current gold standard in selecting which patients are likely to benefit from endoscopic sphincterotomy (ES). It can, however, be misleading. Several non-invasive investigations were identified. These have poor sensitivities and specificities compared to manometry. There is a paucity of data examining the investigation's specific ability to select patients for ES. Outcomes of ES for Type I SOD are favourable irrespective of manometry. Types II and III SOD may respond to an initial trial of medical therapy. Manometry may predict response to ES in Type II SOD, but not in Type III.
CONCLUSIONS
Non-invasive investigations currently lack sufficient sensitivities and specificities for routine use in diagnosing SOD. Type I SOD should be treated with ES without manometry. Manometry may be useful for Type II SOD. However, whilst data is lacking a therapeutic trial of Botox(TM) or trial stenting may bean alternative. Careful and thorough patient counselling is essential. Type III SOD is associated with high complications from manometry and poor outcomes from ES. Alternative diagnoses should be thoroughly sought and its management should be medical.

Links

  • Publisher Full Text

    • Authors

    Hall TC, Dennison AR, Garcea G

    Institution

    Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK. tch2@doctors.org.uk

    Source

    Langenbeck's archives of surgery / Deutsche Gesellschaft für Chirurgie 397:6 2012 Aug pg 889-98

    MeSH

    Cholangiopancreatography, Endoscopic Retrograde
    Diagnostic Imaging
    Endosonography
    Follow-Up Studies
    Humans
    Male
    Manometry
    Prospective Studies
    Radionuclide Imaging
    Retrospective Studies
    Risk Assessment
    Severity of Illness Index
    Sphincter of Oddi Dysfunction
    Sphincterotomy, Endoscopic
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    22688754