DO PATIENTS WITH SPHINCTER OF ODDI DYSFUNCTION BENEFIT FROM ENDOSCOPIC SPHINCTEROTOMY - A 5-YEAR PROSPECTIVE TRIAL

Objectives: To assess the incidence of elevated sphincter of Oddi base line pressure and the response to endoscopic sphincterotomy in patient s with suspected sphincter of Oddi dysfunction. Design: A 5-year prosp ective clinical trial. Methods: One-hundred and eight patients with re current biliary-type pain after cholecystectomy were enrolled. After t horough investigation, 35 patients with suspected type II sphincter of Oddi dysfunction (SOD) and another 29 type III patients remained for further investigation. Both groups were similar with respect to demogr aphic data and severity of pain. Biliary manometry was performed in al l except three patients in either group. Endoscopic sphincterotomy was performed in all patients with abnormal sphincter of Oddi baseline pr essure (> 40 mmHg). All patients were clinically re-evaluated after 4- 6 weeks, and thereafter the sphincterotomized patients were followed f or a median period of 2.5 years. Results: An abnormal sphincter of Odd i baseline pressure was found in 62.5% of the type II patients and in 50% of the patients with suspected type III SOD (P = 0.66). At the 4-6 -week follow-up none of those patients without abnormal manometry, but 70% of the patients with type II SOD, and 39% of the type III SOD pat ients, respectively, reported subjective benefit after sphincterotomy (P = 0.13 type II vs. type III). However, after a median follow-up of 2.5 years, sustained symptomatic improvement after sphincterotomy was found in 60% of the type II patients, but only in 8% of the patients w ith type III SOD (P < 0.01). Conclusion: Disregarding a lack of differ ence in the incidence of abnormal sphincter of Oddi baseline pressure between type II and type III SOD, the Geenen-Hogan classification help s to predict the clinical outcome after endoscopic sphincterotomy.