Efficacy evaluation of endoscopic diagnosis and treatment for sphincter of Oddi dysfunction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

REN LIkun ^1,2 , LI XINGzhi ¹ , LIU Hao ¹ , YANG Nenghong ² , ZENG Wenying ² , PAN Yaozhen ³ ,  HAN Min ²

1. School of Clinical Medicine, Guizhou Medical University, Guiyang 550000, P. R. China;
2. Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550000, P. R. China;
3. Department of Hepatobiliary Surgery, Tumor Hospital Affiliated to Guizhou Medical University, Guiyang 550000, P. R. China;

Corresponding?author：

HAN Min, Email: 409582096@qq.com

Keywords：

sphincter of Oddi dysfunction; endoscopic sphincterotomy; biliary type; pancreatic type; efficacy

DOI：

10.7507/1007-9424.202003064

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Objective To explore the efficacy and safety of endoscopic sphincterotomy (EST) in the treatment of sphincter of Oddi dysfunction (SOD).Methods The clinical data of 95 cases of SOD treated with EST in Affiliated Hospital of Guizhou Medical University and Tumor Hospital Affiliated to Guizhou Medical University from January 2014 to January 2019 were collected retrospectively, to evaluate and analyze the effect of clinical diagnosis and treatment of EST on SOD patients.Results Among 95 SOD patients, 86 were biliary type SOD and 9 were pancreatic type SOD. All 95 patients underwent EST. The Verbal Rating Scales-5 (VRS-5) scores before EST were all 3 or 4 points, and the VRS-5 scores decreased after treatment in each type of SOD patients, the difference were all statistically significant (P<0.05). After treatment, levels of ALT, AST, ALP, TBiL, and DBiL in biliary type SOD Ⅰ and type Ⅱ were significantly lower than before (P<0.05); ALT, AST, ALP, GGT, and blood and urine amylase in patients with pancreatic type SOD after EST were significantly decreased than before (P<0.05), and the biochemical indicators of patients with SOD Ⅲ before and after treatment did not change significantly (P>0.05). After EST treatment, 70 (81.4%) of the 86 patients with bile type SOD showed significant effect, and 10 patients (11.6%) were effective, with an overall effective rate of 93.0% (80/86). Among the 16 patients with bile type SOD Ⅰ, 14 patients (87.5%) received significant effect, and 1 patient (6.3%) was effective, with an overall effective rate of 93.8% (15/16). That 51 patients with bile type SOD Ⅱ received EST, of which 43 patients (84.3%) were significantly effective and 6 patients (11.8%) were effective, with an overall response rate of 96.1% (49/51). Among the 19 patients with bile type SOD Ⅲ treated with EST, 13 patients (68.4%) were significantly effective and 3 patients (15.8%) were effective, with the overall effective rate was 84.2% (16/19). There was no statistically significant difference in the overall effective rate of patients with 3 types of biliary type SOD patients (P>0.05). Endoscopic treatment was effective in all 9 cases of pancreatic type SOD, with an overall effective rate of 100%. There were 5 patients (5.3%) of acute pancreatitis after EST, and no bleeding, perforation, cholangitis or other complications occurred. All patients were interviewed for 1 to 5 years postoperatively, the median follow-up duration was 2.33 year, during the follow-up period, nolong-term complications such as Oddi sphincter restenosis and cholangitis caused by intestinal bile reflux.Conclusion ESTis a minimally invasive, safe, and effective treatment for SOD in patients with bile duct type and pancreatic duct type, and it is an important treatment for SOD.

Citation： REN LIkun, LI XINGzhi, LIU Hao, YANG Nenghong, ZENG Wenying, PAN Yaozhen, HAN Min. Efficacy evaluation of endoscopic diagnosis and treatment for sphincter of Oddi dysfunction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(12): 1515-1521. doi: 10.7507/1007-9424.202003064 Copy

1.	Kutsumi H, Nobutani K, Kakuyama S, et al. Sphincter of Oddi disorder: what is the clinical issue? Clin J Gastroenterol, 2011, 4(6): 364-370.
2.	韓民, 孫誠誼, 胡韻, 等. 內鏡下十二指腸乳頭括約肌切開術治療Oddi括約肌功能障礙42例臨床分析. 中國普外基礎與臨床雜志, 2011, 18(10): 1091-1094.
3.	Behar J, Corazziari E, Guelrud M, et al. Functional gallbladder and sphincter of oddi disorders. Gastroenterology, 2006, 130(5): 1498-1509.
4.	高萬露, 汪小海. 患者疼痛評分法的術前選擇及術后疼痛評估的效果分析. 實用醫學雜志, 2013, 29(23): 3892-3894.
5.	Miyatani H, Mashima H, Sekine M, et al. Clinical course of biliary-type sphincter of Oddi dysfunction: endoscopic sphincterotomy and functional dyspepsia as affecting factors. Ther Adv Gastrointest Endosc, 2019, 12: 2631774519867184.
6.	Sugiyama M, Atomi Y. Follow-up of more than 10 years after endoscopic sphincterotomy for choledocholithiasis in young patients. Br J Surg, 1998, 85(7): 917-921.
7.	Drossman DA. The functional gastrointestinal disorders and the Rome Ⅲ process. Gastroenterology, 2006, 130(5): 1377-1390.
8.	Kyanam Kabir Baig KR, Wilcox CM. Translational and clinical perspectives on sphincter of Oddi dysfunction. Clin Exp Gastroenterol, 2016, 9: 191-195.
9.	Tarnasky PR. Post-cholecystectomy syndrome and sphincter of Oddi dysfunction: past, present and future. Expert Rev Gastroenterol Hepatol, 2016, 10(12): 1359-1372.
10.	McLoughlin MT, Mitchell RM. Sphincter of Oddi dysfunction and pancreatitis. World J Gastroenterol, 2007, 13(47): 6333-6343.
11.	中華醫學會消化內鏡學分會ERCP學組, 中國醫師協會消化醫師分會膽胰學組, 國家消化系統疾病臨床醫學研究中心. 中國ERCP指南 (2018版). 中華消化內鏡雜志, 2018, 35(11): 777-813.
12.	Geenen JE, Hogan WJ, Dodds WJ, et al. The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med, 1989, 320(2): 82-87.
13.	Guelrud M, Plaz J, Mendoza S, et al. Endoscopic treatment in type-Ⅱ pancreatic sphincter dysfunction. Gastrointest Endosc, 1995, 41(4): 398.
14.	王永向, 吳濤, 紀宗正, 等. 膽囊切除術后奧狄括約肌功能障礙的內鏡治療. 中華消化內鏡雜志, 2002, 19(1): 21-23.
15.	Toouli J, Roberts-Thomson IC, Kellow J, et al. Manometry based randomised trial of endoscopic sphincterotomy for sphincter of Oddi dysfunction. Gut, 2000, 46(1): 98-102.
16.	Sugawa C, Park DH, Lucas CE, et al. Endoscopic sphincterotomy for stenosis of the sphincter of Oddi. Surg Endosc, 2001, 15(9): 1004-1007.
17.	Afghani E, Lo SK, Covington PS, et al. Sphincter of Oddi function and risk factors for dysfunction. Front Nutr, 2017, 4: 1.
18.	Morgan KA, Romagnuolo J, Adams DB. Transduodenal sphincteroplasty in the management of sphincter of Oddi dysfunction and pancreas divisum in the modern era. J Am Coll Surg, 2008, 206(5): 908-914.
19.	Arguedas MR, Linder JD, Wilcox CM. Suspected sphincter of Oddi dysfunction type Ⅱ: empirical biliary sphincterotomy or manometry-guided therapy? Endoscopy, 2004, 36(2): 174-178.
20.	Cotton PB, Durkalski V, Romagnuolo J, et al. Effect of endoscopic sphincterotomy for suspected sphincter of Oddi dysfunction on pain-related disability following cholecystectomy: the EPISOD randomized clinical trial. JAMA, 2014, 311(20): 2101-2109.
21.	朱興, 孫鐸, 楊俊青. ERCP診治單純膽囊切除術后腹痛的體會 (附43例報道). 中國普外基礎與臨床雜志, 2014, 21(10): 1287-1288.
22.	Grendell JH. Idiopathic acute pancreatitis. Gastroenterol Clin North Am, 1990, 19(4): 843-848.
23.	Ballinger AB, Barnes E, Alstead EM, et al. Is intervention necessary after a first episode of acute idiopathic pancreatitis? Gut, 1996, 38(2): 293-295.
24.	Fazel A, Geenen JE, MoezArdalan K, et al. Intrapancreatic ductal pressure in sphincter of Oddi dysfunction. Pancreas, 2005, 30(4): 359-362.
25.	Tarnasky PR. Division of the sphincter of Oddi for treatment of dysfunction associated with recurrent pancreatitis. Gastrointest Endosc, 1997, 45(5): 444-446.
26.	Kaw M, Brodmerkel GJ. ERCP, biliary crystal analysis, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis. Gastrointest Endosc, 2002, 55(2): 157-162.
27.	Sherman S. Idiopathic acute pancreatitis: role of ERCP in diagnosis and therapy. Clinical Update, 2005, 12(1): 1-4.
28.	Coté GA, Imperiale TF, Schmidt SE, et al. Similar efficacies of biliary, with or without pancreatic, sphincterotomy in treatment of idiopathic recurrent acute pancreatitis. Gastroenterology, 2012, 143(6): 1502-1509.
29.	金正, 盧祎, 吳嘉釧, 等. Oddi括約肌功能障礙的治療進展. 國際消化病雜志, 2015, 35(4): 283-285, 292.

1. Kutsumi H, Nobutani K, Kakuyama S, et al. Sphincter of Oddi disorder: what is the clinical issue? Clin J Gastroenterol, 2011, 4(6): 364-370.
2. 韓民, 孫誠誼, 胡韻, 等. 內鏡下十二指腸乳頭括約肌切開術治療Oddi括約肌功能障礙42例臨床分析. 中國普外基礎與臨床雜志, 2011, 18(10): 1091-1094.
3. Behar J, Corazziari E, Guelrud M, et al. Functional gallbladder and sphincter of oddi disorders. Gastroenterology, 2006, 130(5): 1498-1509.
4. 高萬露, 汪小海. 患者疼痛評分法的術前選擇及術后疼痛評估的效果分析. 實用醫學雜志, 2013, 29(23): 3892-3894.
5. Miyatani H, Mashima H, Sekine M, et al. Clinical course of biliary-type sphincter of Oddi dysfunction: endoscopic sphincterotomy and functional dyspepsia as affecting factors. Ther Adv Gastrointest Endosc, 2019, 12: 2631774519867184.
6. Sugiyama M, Atomi Y. Follow-up of more than 10 years after endoscopic sphincterotomy for choledocholithiasis in young patients. Br J Surg, 1998, 85(7): 917-921.
7. Drossman DA. The functional gastrointestinal disorders and the Rome Ⅲ process. Gastroenterology, 2006, 130(5): 1377-1390.
8. Kyanam Kabir Baig KR, Wilcox CM. Translational and clinical perspectives on sphincter of Oddi dysfunction. Clin Exp Gastroenterol, 2016, 9: 191-195.
9. Tarnasky PR. Post-cholecystectomy syndrome and sphincter of Oddi dysfunction: past, present and future. Expert Rev Gastroenterol Hepatol, 2016, 10(12): 1359-1372.
10. McLoughlin MT, Mitchell RM. Sphincter of Oddi dysfunction and pancreatitis. World J Gastroenterol, 2007, 13(47): 6333-6343.
11. 中華醫學會消化內鏡學分會ERCP學組, 中國醫師協會消化醫師分會膽胰學組, 國家消化系統疾病臨床醫學研究中心. 中國ERCP指南 (2018版). 中華消化內鏡雜志, 2018, 35(11): 777-813.
12. Geenen JE, Hogan WJ, Dodds WJ, et al. The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med, 1989, 320(2): 82-87.
13. Guelrud M, Plaz J, Mendoza S, et al. Endoscopic treatment in type-Ⅱ pancreatic sphincter dysfunction. Gastrointest Endosc, 1995, 41(4): 398.
14. 王永向, 吳濤, 紀宗正, 等. 膽囊切除術后奧狄括約肌功能障礙的內鏡治療. 中華消化內鏡雜志, 2002, 19(1): 21-23.
15. Toouli J, Roberts-Thomson IC, Kellow J, et al. Manometry based randomised trial of endoscopic sphincterotomy for sphincter of Oddi dysfunction. Gut, 2000, 46(1): 98-102.
16. Sugawa C, Park DH, Lucas CE, et al. Endoscopic sphincterotomy for stenosis of the sphincter of Oddi. Surg Endosc, 2001, 15(9): 1004-1007.
17. Afghani E, Lo SK, Covington PS, et al. Sphincter of Oddi function and risk factors for dysfunction. Front Nutr, 2017, 4: 1.
18. Morgan KA, Romagnuolo J, Adams DB. Transduodenal sphincteroplasty in the management of sphincter of Oddi dysfunction and pancreas divisum in the modern era. J Am Coll Surg, 2008, 206(5): 908-914.
19. Arguedas MR, Linder JD, Wilcox CM. Suspected sphincter of Oddi dysfunction type Ⅱ: empirical biliary sphincterotomy or manometry-guided therapy? Endoscopy, 2004, 36(2): 174-178.
20. Cotton PB, Durkalski V, Romagnuolo J, et al. Effect of endoscopic sphincterotomy for suspected sphincter of Oddi dysfunction on pain-related disability following cholecystectomy: the EPISOD randomized clinical trial. JAMA, 2014, 311(20): 2101-2109.
21. 朱興, 孫鐸, 楊俊青. ERCP診治單純膽囊切除術后腹痛的體會 (附43例報道). 中國普外基礎與臨床雜志, 2014, 21(10): 1287-1288.
22. Grendell JH. Idiopathic acute pancreatitis. Gastroenterol Clin North Am, 1990, 19(4): 843-848.
23. Ballinger AB, Barnes E, Alstead EM, et al. Is intervention necessary after a first episode of acute idiopathic pancreatitis? Gut, 1996, 38(2): 293-295.
24. Fazel A, Geenen JE, MoezArdalan K, et al. Intrapancreatic ductal pressure in sphincter of Oddi dysfunction. Pancreas, 2005, 30(4): 359-362.
25. Tarnasky PR. Division of the sphincter of Oddi for treatment of dysfunction associated with recurrent pancreatitis. Gastrointest Endosc, 1997, 45(5): 444-446.
26. Kaw M, Brodmerkel GJ. ERCP, biliary crystal analysis, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis. Gastrointest Endosc, 2002, 55(2): 157-162.
27. Sherman S. Idiopathic acute pancreatitis: role of ERCP in diagnosis and therapy. Clinical Update, 2005, 12(1): 1-4.
28. Coté GA, Imperiale TF, Schmidt SE, et al. Similar efficacies of biliary, with or without pancreatic, sphincterotomy in treatment of idiopathic recurrent acute pancreatitis. Gastroenterology, 2012, 143(6): 1502-1509.
29. 金正, 盧祎, 吳嘉釧, 等. Oddi括約肌功能障礙的治療進展. 國際消化病雜志, 2015, 35(4): 283-285, 292.

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Efficacy evaluation of endoscopic diagnosis and treatment for sphincter of Oddi dysfunction

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