Gastrointestinal Endoscopy
Volume 59, Issue 6 , Pages 670-687 , May 2004

Sphincter of Oddi dysfunction, part 2: evidence-based review of the presentations, with “objective” pancreatic findings (types I and II) and of presumptive type III

  • Bret T Petersen, MD

      Affiliations

    • Corresponding Author InformationReprint requests: Bret T. Petersen, MD, Charlton 8 North - GI Endoscopy, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905.

References 

  1. Petersen B. An evidence-based review of sphincter of Oddi dysfunction: (part I, presentations with “objective” biliary findings (types I and II)). Gastrointest Endosc. 2004;59:525–534
  2. McDonald J, Burroughs A, Feagan B. Evidence based gastroenterology and hepatology. London: BMJ; 1999;
  3. Clain JE, Pearson RK. Evidence-based approach to idiopathic pancreatitis. Curr Gastroenterol Rep. 2002;4:128–134
  4. Sherman S. What is the role of ERCP in the setting of abdominal pain of pancreatic or biliary origin (suspected sphincter of Oddi dysfunction)?. Gastrointest Endosc. 2002;56:S258–S266
  5. Di Francesco V, Brunori MP, Rigo L, Toouli J, Angelini G, Frulloni L, et al.  Comparison of ultrasound-secretin test and sphincter of Oddi manometry in patients with recurrent acute pancreatitits. Dig Dis Sci. 1999;44:336–340
  6. Laugier R. Dynamic endoscopic manometry of the response to secretin in patients with chronic pancreatitis. Endoscopy. 1994;26:222–227
  7. Laugier R. Endoscopic manometry of the sphincter of Oddi and pancreatic duct in patients with chronic pancreatitis. Int J Pancreatol. 1997;21:273–274
  8. Toouli J, Roberts-Thomson IC, Dent J, Lee J. Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis. Br J Surg. 1985;72:859–863
  9. Smithline A, Hawes R, Lehman G. Sphincter of Oddi manometry: inter-observer variability. Gastrointest Endosc. 1993;39:486–491
  10. Thune A, Scicchitano J, Roberts-Thomson I, Toouli J. Reproducibility of endoscopic sphincter of Oddi manometry. Dig Dis Sci. 1991;36:1401–1405
  11. Boyden EA. The anatomy of the choledochoduodenal junction in man. Surg Gynecol Obstet. 1957;104:641–652
  12. Funch-Jensen P, Kruse A. Manometric activity of the pancreatic duct sphincter in patients with total bile duct sphincterotomy for sphincter of Oddi dyskinesia. Scand J Gastroenterol. 1987;22:1067–1070
  13. Raddawi HM, Geenen JE, Hogan WJ, Dodds WJ, Venu RP, Johnson GK. Pressure measurements from biliary and pancreatic segments of sphincter of Oddi: comparison between patients with functional abdominal pain, biliary, or pancreatic disease. Dig Dis Sci. 1991;36:71–74
  14. Eversman D, Fogel EL, Rusche M, Sherman S, Lehman G. Frequency of abnormal pancreatic and biliary sphincter manometry compared with clinical suspicion of sphincter of Oddi dysfunction. Gastrointest Endosc. 1999;50:637–641
  15. Chan YI, Evans PR, Dowsett JF, Kellow JE, Babcock CA. Discordance of pressure recordings from biliary and pancreatic duct segments in patients with suspected sphincter of Oddi dysfunction. Dig Dis Sci. 1997;42:1501–1506
  16. Aymerich RR, Prakash C, Aliperti G. Sphincter of Oddi manometry: is it necessary to measure both biliary and pancreatic sphincter pressures?. Gastrointest Endosc. 2000;52:183–186
  17. Silverman WB, Ruffolo TA, Sherman S, Hawes RH, Lehman GA. Correlation of basal sphincter pressures measured from the bile duct and the pancreatic duct in patients with suspected sphincter of Oddi dysfunction. Gastrointest Endosc. 1992;440–443
  18. Fogel EL, Eversman D, Jamidar P, Sherman S, Lehman GA. Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone. Endoscopy. 2002;34:280–285
  19. Albert MB, Steinberg WM, Irani SK. Severe acute pancreatitis complicating sphincter of Oddi manometry. Gastrointest Endosc. 1988;34:342–345
  20. Maldonado ME, Brady PG, Mamel JJ, Robinson B. Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry (SOM). Am J Gastroenterol. 1999;94:387–390
  21. Tarnasky P, Cunningham J, Cotton P, Hoffman B, Palesch Y, Freeman J, et al.  Pancreatic sphincter hypertension increases the risk of post-ERCP pancreatitis. Endoscopy. 1997;29:252–257
  22. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al.  Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918
  23. Sherman S, Troiano FP, Hawes RH, Lehman GA. Sphincter of Oddi manometry: decreased risk of clinical pancreatitis with use of a modified aspirating catheter. Gastrointest Endosc. 1990;36:462–466
  24. Tarnasky P, Palesch YY, Cunningham JT, Mauldin PD, Cotton PB, Hawes RH. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology. 1998;115:1518–1524
  25. Aizawa T, Ueno N. Stent placement in the pancreatic duct prevents pancreatitis after endoscopic sphincter dilation for removal of bile duct stones. Gastrointest Endosc. 2001;54:209–213
  26. Fazel A, Quadri A, Catalano M, Meyerson S, Geenen J. Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc. 2003;57:291–294
  27. Kaw M, Brodmerkel G. ERCP, biliary crystal analysis, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis. Gastrointest Endosc. 2002;55:157–162
  28. Coyle WJ, Pineau BC, Tarnasky PR, Knapple WL, Aabakken L, Hoffman BJ, et al.  Evaluation of unexplained acute and acute recurrent pancreatitis using endoscopic retrograde cholangiopancreatography, sphincter of Oddi manometry and endoscopic ultrasound. Endoscopy. 2002;34:617–623
  29. Levy M. The hunt for microlithiasis in idiopathic acute recurrent pancreatitis: should we abandon the search or intensify our efforts?. Gastrointest Endosc. 2002;55:286–293
  30. Quallich LG, Stern MA, Rich M, Chey WD, Barnett JL, Elta GH. Bile duct crystals do not contribute to sphincter of Oddi dysfunction. Gastrointest Endosc. 2002;55:163–166
  31. Venu RP, Geenen JE, Hogan W, Stone J, Johnson GK, Soergel K. Idiopathic recurrent pancreatitis. An approach to diagnosis and treatment. Dig Dis Sci. 1989;34:56–60
  32. Sherman S, Jamidar P, Reber H. Idiopathic acute pancreatitis (IAP): endoscopic approach to diagnosis and therapy. [abstract] Am J Gastroenterol. 1993;88:1541
  33. Geenen JE, Nash JA. The role of sphincter of Oddi manometry (SOM) and biliary microscopy in evaluating idiopathic recurrent pancreatitis. Endoscopy. 1998;30:A237–A241
  34. Sherman S, Troiano FP, Hawes RH, O'Connor KW, Lehman GA. Frequency of abnormal sphincter of Oddi manometry compared with the clinical suspicion of sphincter of Oddi dysfunction. Am J Gastroenterol. 1991;86:586–590
  35. Eversman D, Fogel EL, Phillips S, Sherman S, Lehman GA. Sphincter of Oddi dysfunction (SOD): long-term outcome of biliary sphincterotomy (BES) correlated with abnormal biliary and pancreatic sphincters. [abstract] Gastrointest Endosc. 1999;49:78
  36. Toouli J, Di Francesco V, Saccone G, Kollias J, Schloithe A, Shanks N. Division of the sphincter of Oddi for treatment of dysfunction associated with recurrent pancreatitis. Br J Surg. 1996;83:1205–1210
  37. Elton E, Howell DA, Parsons WG, Qaseem T, Hanson BL. Endoscopic pancreatic sphincterotomy: indications, outcome, and a safe stentless technique. Gastrointest Endosc. 1998;47:240–249
  38. Okolo PI, Pasricha PJ, Kalloo AN. What are the long-term results of endoscopic pancreatic sphincterotomy?. Gastrointest Endosc. 2000;52:15–19
  39. Guelrud M, Plaz J, Mendoza S, Beker B, Rojas O, Rossiter G. Endoscopic treatment in type II pancreatic sphincter dysfunction. [abstract] Gastrointest Endosc. 1995;41:398
  40. Park SH, Watkins JL, Fogel EL, Sherman S, Lazzell L, Bucksot L, et al.  Long-term outcome of endoscopic dual pancreatobiliary sphincterotomy in patients with manometry-documented sphincter of Oddi dysfunction and normal pancreatogram. Gastrointest Endosc. 2003;57:483–491
  41. Fogel EL, Eversman D, Jamidar P, Sherman S, Lehman GA. Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone. Endoscopy. 2002;34:280–285
  42. Vestergaard H, Kruse A, Rokkjaer M, Frobert O, Thommesen P, Funch-Jensen P. Endoscopic manometry of the sphincter of Oddi and the pancreatic and biliary ducts in patients with chronic pancreatitis. Scand J Gastroenterol. 1994;29:188–192
  43. Rolny P, Arleback A, Funch-Jensen P, Kruse A, Jarnerot G. Clinical significance of manometric assessment of both pancreatic duct and bile duct sphincter in the same patient. Scand J Gastroenterol. 1989;24:751–754
  44. Okazaki K, Yamamoto Y, Kagiyama S, Tamura S, Sakamoto Y, Nakazawa Y, et al.  Pressure of papillary sphincter zone and pancreatic main duct in patients with chronic pancreatitis in the early stage. Scand J Gastroenterol. 1988;23:501–507
  45. Novis BH, Bornman PC, Girdwood AW, Marks IN. Endoscopic manometry of the pancreatic duct and sphincter zone in patients with chronic pancreatitis. Dig Dis Sci. 1985;30:225–228
  46. Rolny P, Arleback A, Jarnerot G, Andersson T. Endoscopic manometry of the sphincter of Oddi and pancreatic duct in chronic pancreatitis. Scand J Gastroenterol. 1986;21:415–420
  47. Okazaki K, Yamamoto Y, Ito K. Endoscopic measurement of papillary sphincter zone and pancreatic main ductal pressure in patients with chronic pancreatitis. Gastroenterology. 1986;91:409–418
  48. Tarnasky PR, Hoffman B, Aabakken L, Knapple W, Coyle W, Pineau B, et al.  Sphincter of Oddi dysfunction is associated with chronic pancreatitis. Am J Gastroenterol. 1997;92:1125–1129
  49. Sherman S, Lehman G, Jamidar P, Hawes R, Silverman W, Madura J, et al.  Efficacy of endoscopic sphincterotomy and surgical sphincteroplasty for patients with sphincter of Oddi dysfunction (SOD): randomized, controlled study. [abstract] Gastrointest Endosc. 1994;40:P125
  50. Evans PR, Dowsett JF, Bak YT, Chan YK, Kellow JE. Abnormal sphincter of Oddi response to cholecystokinin in postcholecystectomy syndrome patients with irritable bowel syndrome: the irritable sphincter. Dig Dis Sci. 1995;40:1149–1156
  51. Evans PR, Bak YT, Dowsett JF, Smith RC, Kellow JE. Small bowel dysmotility in patients with postcholecystectomy sphincter of Oddi dysfunction. Dig Dis Sci. 1997;42:1507–1512
  52. Soffer EE, Johlin FC. Intestinal dysmotility in patients with sphincter of Oddi dysfunction: a reason for failed response to sphincterotomy. Dig Dis Sci. 1994;39:1942–1946
  53. Botoman VA, Kozarek RA, Novell LA, Patterson DJ, Ball TJ, Gelfand MD, et al.  Gastroparesis in patients with unexplained biliary colic and suspected sphincter of Oddi dysfunction. [abstract] Gastroenterology. 1992;102:A303
  54. Johnson DA, Cattau EL, Winters C. Biliary dyskinesia with associated high amplitude esophageal peristaltic contractions. Am J Gastroenterol. 1986;81:254–256
  55. Chun A, Desautels S, Slivka A, Mitrani C, Starz T, DiLorenzo C, et al.  Visceral algesia in irritable bowel syndrome, fibromyalgia, and sphincter of Oddi dysfunction, type III. Dig Dis Sci. 1999;44:631–636
  56. Abraham HD, Anderson C, Lee D. Somatization disorder in sphincter of Oddi dysfunction. Psychosom Med. 1997;59:459–466
  57. Thatcher BS, Sivak MV, Tedesco FJ, Vennes JA, Hutton SW, Achkar EA. Endoscopic sphincterotomy for suspected dysfunction of the sphincter of Oddi. Gastrointest Endosc. 1987;33:91–95
  58. Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Venu RP. The efficacy of endoscopic sphincterotomy after cholecystectomy inpatients with sphincter-of-Oddi dysfunction. N Engl J Med. 1989;320:82–87
  59. Fullarton GM, Murray WR. Evaluation of endoscopic sphincterotomy in sphincter of Oddi dysfunction. Endoscopy. 1992;24:199–202
  60. Rolny P, Geenen JE, Hogan WJ. Post-cholecystectomy patients with “objective signs” of partial bile outflow obstruction: clinical characteristics, sphincter of Oddi manometry findings, and results of therapy. Gastrointest Endosc. 1993;39:778–781
  61. Botoman VA, Kozarek RA, Novell LA, Patterson DJ, Ball TJ, Wechter DG, et al.  Long-term outcome after endoscopic sphincterotomy in patients with biliary colic and suspected sphincter of Oddi dysfunction. Gastrointest Endosc. 1994;40:165–170
  62. Viceconti G, Micheletti A. Endoscopic manometry of the sphincter of Oddi: its usefulness for the diagnosis and treatment of benign papillary stenosis. Scand J Gastroenterol. 1995;30:797–803
  63. Bozkurt T, Orth KH, Butsch B, Lux G. Long-term clinical outcome of post-cholecystectomy patients with biliary-type pain: results of manometry, non-invasive techniques and endoscopic sphincterotomy. Eur J Gastroenterol Hepatol. 1996;8:245–249
  64. Wehrmann T, Wiemer K, Lembcke B, Caspary WF, Jung M. Do patients with sphincter of Oddi dysfunction benefit from endoscopic sphincterotomy? A 5-year trial. Eur J Gastroenterol Hepatol. 1996;8:251–256
  65. Rolny P. Endoscopic bile duct stent placement as a predictor of outcome following endoscopic sphincterotomy in patients with suspected sphincter of Oddi dysfunction. Eur J Gastroenterol Hepatol. 1997;9:467–471
  66. 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;93:1833–1836
  67. Toouli J, Roberts-Thomson IC, Kellow J, Dowsett J, Saccone GT, Evans P, et al.  Manometry based randomised trial of endoscopic sphincterotomy for sphincter of Oddi dysfunction. Gut. 2000;46:98–102
  68. Cicala M, Habib FI, Vavassori P, Pallotta N, Schillaci O, Costamagna G, et al.  Outcome of endoscopic sphincterotomy in post-cholecystectomy patients with sphincter of Oddi dysfunction as predicted by manometry and quantitative choledochoscintigraphy. Gut. 2002;50:665–668
  69. Guelrud M, Siegel JH. Hypertensive pancreatic duct sphincter as a cause of pancreatitis: successful treatment with hydrostatic balloon dilatation. Dig Dis Sci. 1984;29:225–231
  70. Guelrud M, Mendoza S, Viera L. Idiopathic recurrent pancreatitis and hypercontractile sphincter of Oddi. Treatment with endoscopic sphincterotomy and pancreatic duct dilation. [abstract] Gastroenterology. 1986;90:1443
  71. Stone JE, Hogan WHJ, Geenen JE, Wilson SD, Dodds WJ. Acute recurrent pancreatitis: the role of sphincter-of-Oddi (SO) manometry in predicting long-term benefit of therapy. [abstract] Gastroenterology. 1988;94:A446
  72. McCarthy J, Geenen JE, Hogan WJ. Preliminary experience with endoscopic stent placement in benign pancreatic diseases. Gastrointest Endosc. 1988;34:16–18
  73. Catalano MF, Sivak MV, Falk GW, Howerton HD, Achkar E. Idiopathic pancreatitis (IP): diagnostic role of sphincter of Oddi manometry (SOM) and response to endoscopic sphincterotomy (ES). [abstract] Gastrointest Endosc. 1993;39:310
  74. Guelrud M, Plaz J, Mendoza S. Endoscopic treatment in type II pancreatic sphincter dysfunction. [abstract] Gastroenterology. 1986;90:1443
  75. Wehrmann T, Zipf A, Caspary WF, Jung M. Sphincter of Oddi dysfunction in idiopathic recurrent pancreatitis of unknown cause. Dtsch Med Wochenschr. 1996;121:781–787
  76. Guelrud M, Morera C, Rodriquez M, Jaen D, Pierre R. Sphincter of Oddi dysfunction in children with recurrent pancreatitis and anomalous pancreaticobiliary union: an etiologic concept. Gastrointest Endosc. 1999;50:194–199
  77. Jacob L, Geenen JE, Catalano MF, Geenen DJ. Prevention of pancreatitis in patients with idiopathic recurrent pancreatitis: a prospective nonblinded randomized study using endoscopic stents. Endoscopy. 2001;33:559–562
  78. Goff JS. Common bile duct sphincter of Oddi stenting in patients with suspected sphincter dysfunction. Am J Gastroenterol. 1995;90:586–589
  79. Wehrmann T, Seifert H, Seipp M, Lembcke B, Caspary WF. Endoscopic injection of botulinum toxin for biliary sphincter of Oddi dysfunction. Endoscopy. 1998;30:702–707

PII: S0016-5107(04)00297-4

Gastrointestinal Endoscopy
Volume 59, Issue 6 , Pages 670-687 , May 2004