SPHINCTER OF ODDI DYSFUNCTION IN PATIENTS WITH INTACT GALLBLADDER - THERAPEUTIC RESPONSE TO ENDOSCOPIC SPHINCTEROTOMY

Increasing evidence exists of the occurrence of sphincter of Oddi dysf unction in patients with an intact gallbladder. Optimal therapy for su ch patients has not been defined. From 1989 to 1991, 35 patients with sphincter of Oddi dysfunction (abnormal basal sphincter pressure >40 m m Hg) and an intact gallbladder were identified. The patients with abn ormal ductography (except for duct dilation), pancreas divisum, or pan creatobiliary malignancy were excluded. All patients had disabling upp er abdominal pain, which was quantified on a 0 = none to 10 = severe p ain scale. All patients received standard endoscopic biliary sphincter otomy and were followed up for 4 to 26 months with a mean of 13 months . Initially, 27 of 35 patients (77%) showed at least 50% improvement i n the pain score, whereas only 15 of the 27 remained improved througho ut the follow-up interval. Patients who were unimproved or had relapse s were offered cholecystectomy and 11 patients underwent the procedure . These patients were followed up after cholecystectomy for 2 to 24 mo nths, with a mean of 13 months. Eight of 11 were improved. In summary, the combination of endoscopic sphincterotomy and selective cholecyste ctomy and minimal medical treatment resulted in a good and excellent r esponse rate of 68%. Better techniques are needed to select patients w ho will respond to these therapies.