Tip II Oddi sfinkter disfonksiyonunda biliyer manometri yapmadan sfinkterotomi uygun bir yaklaşım mıdır

Background and Aims: Sphincter of Oddi dysfunction is the circumstance seen in biliary and/or pancreatic obstructions caused by functional or structural abnormalities in the sphincter of Oddi. Endoscopic biliary sphincterotomy is an effective therapy in most of the patients with type I Sphincter of Oddi dysfunction, which includes an episodic biliary pain, a dilated extrahepatic bile duct and biliary enzyme elevations. The presence of only pain indicates type III Sphincter of Oddi dysfunction, and endoscopic sphincterotomy is effective especially in those with high sphincter pressure. For this reason, sphincter of Oddi manometry is proposed in type III Sphincter of Oddi dysfunction. The necessity of sphincter of Oddi manometry before sphincterotomy remains controversial in type II Sphincter of Oddi dysfunction, which has biliary pain along with a dilated extrahepatic bile duct or biliary enzyme elevations. In this study, it was aimed to evaluate the response to endoscopic sphincterotomy in patients with type II Sphincter of Oddi dysfunction. Materials and Methods: The data obtained prospectively from patients with type I and II Sphincter of Oddi dysfunction between July 2005 and September 2008 were retrospectively investigated. The success and complications of papillotomy and the response of biliary pain after endoscopic sphincterotomy were ascertained. Results: During this period, 30 patients [27 female, 3 male, mean ± SD age: 58.6 ± 18.3 (25-88) years] were recognized as having Sphincter of Oddi dysfunction. Eighteen patients were classified as type I and remaining patients as type II Sphincter of Oddi dysfunction. Six (20%) patients had fibrotic sphincter of Oddi. Selective biliary cannulation was done in 18 patients, but 12 patients required needle-knife pre-cut before selective biliary cannulation. Later, the endoscopic sphincterotomy was completed in all patients, and all procedures were successful. Postprocedural mild pancreatitis was described in only one patient (3.3%). The patients were followed-up for a mean 21.4±10.8 (2-38) months. In the type I Sphincter of Oddi dysfunction group, no recurrent symptoms were established in 15 (83.3%) patients, but continuous symptoms were defined in 3 (16.7%) patients. In the type II Sphincter of Oddi dysfunction group, no recurrent symptoms were established in 8 (66%) patients, but continuous symptoms were defined in 4 (34%) patients. When these patients were investigated in detail, it was found that their symptoms were consistent with the other functional gastrointestinal diseases. Conclusions: Endoscopic sphincterotomy is a highly effective procedure in patients with Sphincter of Oddi dysfunction type I. endoscopic sphincterotomy without sphincter of Oddi manometry can be recommended in these patients. In our group of patients, the frequency of biliary pancreatitis was lower than found in the literature. According to our data, although endoscopic sphincterotomy-related symptomatic relief is low in type II Sphincter of Oddi dysfunction, it is logical to perform endoscopic sphincterotomy directly because of the pancreatitis risk due to sphincter of Oddi manometry.