Biliary and pancreatic sphincter of Oddi disorder

Abstract

AbstractDysfunction of the sphincter of Oddi is considered to be due to an episodic increased pressure. The ROME III classification, the previously widely accepted framework for defining the condition, has now been replaced by the ROME IV classification. This is largely due to evidence from the EPISOD trial which indicated that sphincter of Oddi manometry did not predict the response to endoscopic sphincterotomy. A systematic and structured approach towards investigating patients who present with post-cholecystectomy biliary- or pancreatic-type pain is imperative in this complex group before their symptoms are attributed to sphincter of Oddi dysfunction. Endoscopic ultrasound can play an important role in identifying occult choledocholithiasis. Endoscopic retrograde cholangiopancreatography on the other hand carries risks in this setting and clear evidence for its benefit is limited to the management of common bile duct stones and papillary stenosis. Biliary and pancreatic sphincter of Oddi dysfunction is likely to be the cause of post-cholecystectomy pain in a small minority of these patients. The majority will have no structural cause identified and will have functional abdominal pain, the aetiology of which is unclear but represents a complex multifactorial disorder of the brain–gut axis.