Tags

Type your tag names separated by a space and hit enter

Sphincterotomy for biliary sphincter of Oddi dysfunction.
Cochrane Database Syst Rev 2001; (3):CD001509CD

Abstract

BACKGROUND

The sphincter of Oddi regulates both bile and pancreatic juice flow into the duodenum. When dysfunction occurs it leads to problems relating to either the bile or pancreatic ducts. On the biliary side, the most common problem is recurrent biliary type pain following cholecystectomy.

OBJECTIVES

Is sphincterotomy effective treatment for biliary sphincter of Oddi dysfunction patients?

SEARCH STRATEGY

Electronic data bases, including the Collaborative Review Group trial registers, MEDLINE, and EMBASE, as well as checking reference lists in as many languages as possible that had the titles: sphincter of Oddi dysfunction, biliary dyskinesia, papillary stenosis, biliary dyssynergia, odditis, papillitis, post-cholecystectomy pain, right upper quadrant pain, or unexplained right upper quadrant pain were included. These titles were matched with sphincterotomy.

SELECTION CRITERIA

Randomised placebo-controlled trials performing sphincterotomy in patients with suspected biliary sphincter of Oddi dysfunction using manometry as part of the patient evaluation. A basal pressure > 40 mmHg was defined as abnormal. The primary outcome measure were symptomatic response (defined either as cure/improvement or not improved) to sphincterotomy.

DATA COLLECTION AND ANALYSIS

Electronic data bases were used to search for the studies. Studies were attempted to be stratified as randomised clinical trials, controlled clinical trials (i.e., quasi-randomised clinical trials), well designed observational studies using a well matched control group, or other. These groupings were then entered into a meta-analysis.

MAIN RESULTS

Only two randomised clinical trials met the inclusion criteria. In 49 patients studied, sphincterotomy was more effective than placebo in treating patients with an elevated basal pressure (Peto odds ratio 9.08, 95% confidence interval 2.97-277.77). In 77 patients studied, sphincterotomy was no better than placebo in treating patients with a normal normal basal pressure (Peto odds ratio 1.28, 95% confidence interval 0.52-3.13). There was no data on quality of life or health economics.

REVIEWER'S CONCLUSIONS

These results suggest that sphincterotomy for biliary sphincter of Oddi dysfunction appears effective in those patients with an elevated sphincter of Oddi basal pressure (>40 mmHg), but is no better than placebo in those patients with a normal basal pressure. The results reported in this review must be interpreted with caution as there are only two studies and one of the reviewers (Toouli) has been an author in both studies. Further trials by independent groups are recommended.

Authors+Show Affiliations

Digestive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia, 5042. sandy.craig@flinders.edu.auNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

11686993

Citation

Craig, A G., and J Toouli. "Sphincterotomy for Biliary Sphincter of Oddi Dysfunction." The Cochrane Database of Systematic Reviews, 2001, p. CD001509.
Craig AG, Toouli J. Sphincterotomy for biliary sphincter of Oddi dysfunction. Cochrane Database Syst Rev. 2001.
Craig, A. G., & Toouli, J. (2001). Sphincterotomy for biliary sphincter of Oddi dysfunction. The Cochrane Database of Systematic Reviews, (3), p. CD001509.
Craig AG, Toouli J. Sphincterotomy for Biliary Sphincter of Oddi Dysfunction. Cochrane Database Syst Rev. 2001;(3)CD001509. PubMed PMID: 11686993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sphincterotomy for biliary sphincter of Oddi dysfunction. AU - Craig,A G, AU - Toouli,J, PY - 2001/11/1/pubmed PY - 2002/3/29/medline PY - 2001/11/1/entrez SP - CD001509 EP - CD001509 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: The sphincter of Oddi regulates both bile and pancreatic juice flow into the duodenum. When dysfunction occurs it leads to problems relating to either the bile or pancreatic ducts. On the biliary side, the most common problem is recurrent biliary type pain following cholecystectomy. OBJECTIVES: Is sphincterotomy effective treatment for biliary sphincter of Oddi dysfunction patients? SEARCH STRATEGY: Electronic data bases, including the Collaborative Review Group trial registers, MEDLINE, and EMBASE, as well as checking reference lists in as many languages as possible that had the titles: sphincter of Oddi dysfunction, biliary dyskinesia, papillary stenosis, biliary dyssynergia, odditis, papillitis, post-cholecystectomy pain, right upper quadrant pain, or unexplained right upper quadrant pain were included. These titles were matched with sphincterotomy. SELECTION CRITERIA: Randomised placebo-controlled trials performing sphincterotomy in patients with suspected biliary sphincter of Oddi dysfunction using manometry as part of the patient evaluation. A basal pressure > 40 mmHg was defined as abnormal. The primary outcome measure were symptomatic response (defined either as cure/improvement or not improved) to sphincterotomy. DATA COLLECTION AND ANALYSIS: Electronic data bases were used to search for the studies. Studies were attempted to be stratified as randomised clinical trials, controlled clinical trials (i.e., quasi-randomised clinical trials), well designed observational studies using a well matched control group, or other. These groupings were then entered into a meta-analysis. MAIN RESULTS: Only two randomised clinical trials met the inclusion criteria. In 49 patients studied, sphincterotomy was more effective than placebo in treating patients with an elevated basal pressure (Peto odds ratio 9.08, 95% confidence interval 2.97-277.77). In 77 patients studied, sphincterotomy was no better than placebo in treating patients with a normal normal basal pressure (Peto odds ratio 1.28, 95% confidence interval 0.52-3.13). There was no data on quality of life or health economics. REVIEWER'S CONCLUSIONS: These results suggest that sphincterotomy for biliary sphincter of Oddi dysfunction appears effective in those patients with an elevated sphincter of Oddi basal pressure (>40 mmHg), but is no better than placebo in those patients with a normal basal pressure. The results reported in this review must be interpreted with caution as there are only two studies and one of the reviewers (Toouli) has been an author in both studies. Further trials by independent groups are recommended. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/11686993/Sphincterotomy_for_biliary_sphincter_of_Oddi_dysfunction L2 - https://doi.org/10.1002/14651858.CD001509 DB - PRIME DP - Unbound Medicine ER -