Objective: Sphincter of Oddi dyskinesia (SOD) remains a challenge todiagnose and treat with patients having variable results. Manometry is the gold standard for this diagnosis. The treatment is controversial, but centers on endoscopic retrograde cholangio-pancreatography with sphincterotomy (ERCP/ES). Transduodenal sphincteroplasty (TS) and pancreaticoduodenectomy are also utilized. We present our experience with longitudinal follow-up of a group of patients with mainly Type III SOD who did not resolve following cholecystectomy for chronic acalculous cholecystitis (CAC).
Methods: Patient charts, including manometry reading, operative reports and imaging were retrospectively reviewed..
Results: 69 patients, predominately female (89%),with a mean age of 52.3 that who did not respond to cholecystectomy were diagnosed with SOD using sphincter of Oddi manometry and clinical criteria. 63 of these patients had manometry studies that were available for interpretation. Normal manometry was found in 23 patients and of those 12(52%) were improved after ERCP/ES. Abnormal manometry was found in 39 patients and of these 25 (64%) had a significant improvement with ERCP/ES alone. 52 (75%) patients had ERCP/ES as their only intervention with 40 (77%) of them having a significant improvement in symptoms and 11 (21%) with complete resolution of symptoms. 12 (23%) patients had initial success with a relapse or no success with ERCP/ES. 43 (83%) of these patients required 3 or fewer interventions. 13 (18%) of the initial patient population required TS. This was done after either initial or long term failure of ERCP/ES. Improvement of symptoms was seen in 10 (77%) patients and resolution in 1. Four (5%) of the initial cohort, that failed both ERCP/ES and TS, underwent pancreaticoduodenectomy. One of these patients had improvement in symptoms. Mean follow-up for this cohort was 21.9 months. Range of follow-up was 1 to 137 months.
Conclusion: Overall, the patients in this study did well. ERCP/ES and TS did decrease or eliminate symptoms in over 73% of patients. Early, aggressive intervention with ERCP/ES and if this fails, then TS may provide more relief to patients with Type III SOD after cholecystectomy for CAC.