LONG-TERM OUTCOME AFTER ENDOSCOPIC SPHINCTEROTOMY IN PATIENTS WITH BILIARY COLIC AND SUSPECTED SPHINCTER OF ODDI DYSFUNCTION

Seventy-three highly selected patients (35 type II, 38 type III) with intractable biliary-type pain were studied with biliary manometry afte r a baseline endoscopic retrograde cholangiopancreatography was normal or showed only duct dilatation. No differences between the two groups were noted in regard to baseline sphincter hypertension (60% versus 5 5%), improvement after endoscopic sphincterotomy at mean follow-up of 3 years, or post-procedure pancreatitis rates (15% versus 16%). Althou gh not statistically significant, a tendency for patients with bile du cts greater than or equal to 12 mm to have sustained clinical improvem ent after sphincterotomy was noted in comparison with patients having ducts <12 mm; an inverse correlation between improvement in symptoms a nd presence of an intact gallbladder at baseline was also seen. The au thors suggest that the current classification, which divides patients with recurrent right upper quadrant pain into types I, II, and III, is inadequate to define either incidence of sphincter of Oddi dysfunctio n or subsequent response to endoscopic sphincterotomy.