Sphincter of Oddi dysfunction and postcholecystectomy syndrome

This chapter aims to clarify what is known concerning nomenclature, diagnosis, and treatment of sphincter of Oddi dysfunction (SOD). Some terms used to describe SOD include papillary stenosis, sclerosing papillitis, biliary spasm, biliary dyskinesia, and postcholecystectomy syndrome. Sphincter of Oddi is divided anatomically into four distinct components: the biliary sphincter, the pancreatic sphincter, the ampullary sphincter, and fasciculi longitudinales. The diagnosis of SOD rests on the presence of typical clinical symptoms in the setting of associated radiographic and laboratory abnormalities. Most centers would recommend that the diagnostic evaluation begin with noninvasive imaging unless the clinical, laboratory, and radiographic evidence clearly suggests SOD. The chapter discusses the various treatment options: pharmacological therapy, acupuncture, surgery, and endoscopy. Patients with confirmed pancreatic SOD on endoscopic retrograde cholangiopancreatography with Sphincter of Oddi manometry had a higher risk for acute recurrent pancreatitis than those without elevated pancreatic ductal pressures on manometry.