Abstract :
Sphincter of Oddi dysfunction (SOD) is the stenosis or dyskinesia of biliary, pancreatic or both sphincters.
Sphincter of Oddi manometry (SOM) is the gold standard for the diagnosis but rarely needed. Biliary SOD mimics
CBD stone but no cause of obstruction is identified. Biliary SOD type I (papillary stenosis) is real and empiric ES
is recommended without the need of SOM. Type II is true in half of the cases. Noninvasive tests or SOM may help
select appropriate patients for ES. Type III is very subjective and may not be real. Response to ES is poor while the
risk is high, thus, medical therapy and reassessment are preferred. Pancreatic SOD is the most controversial. ES has
little and questionable benefit but with significant risks. Other more common causes of IRAP, particularly chronic
pancreatitis should be ruled out before considering pancreatic SOD. |
file/Thai-Journal-of-gastroenterology-vol-15-no-1-3450363.pdf