Sphincter of Oddi dysfunction after successful gallstone lithotripsy (postlithotripsy syndrome) - Manometric data and results of endoscopic sphincterotomy

After successful gallstone lithotripsy, biliary pain recurs in about one th ird of patients. However, gallstone recurrence can be shown in only 40-60% of these patients. Therefore, other causes, such as sphincter of Oddi dysfu nction (SOD), may be suspected. Twenty-two consecutive patients with recurr ent biliary pain after successful gallstone lithotripsy without evidence of gallstone recurrence at ultrasonography were enrolled. Liver tests were el evated in 13 patients and ERC showed a dilated bile duct in nine. All 22 pa tients underwent sphincter of Oddi (SO) manometry, bile sample analysis for microlithiasis, endoscopic sphincterotomy (ES), and bile duct exploration with a Dormia basket. Thereafter, the patients were clinically followed at bimonthly intervals. SO manometry revealed SOD in 15/22 patients. This was more often the case in patients with initially larger (>2 cm) or multiple s tones than after lithotripsy for solitary small stones (P < 0.01). Microlit hiasis was detected in one patient, another patient had small biliary calcu li at bile duct exploration (both without SOD). After ES, 14/15 patients wi th biliary SOD but none of the five without SOD improved (median follow-up: two years; P < 0.01). The one patient with CBD stones became symptom-free after ES, while the patient with microlithiasis improved after additional c holecystectomy only. Overall, ES proved to be the adequate therapy in 15/22 patients (68%, median follow-up: 22 months). After gallstone lithotripsy, SOD is found in about two thirds of patients with recurrent symptoms but wi thout gallstone recurrence. In this group CBD stones or microlithiasis are rare. Therefore, SOD has to be suspected in this situation and ES gives fav orable results, even when performed on a clinical basis only (without SO ma nometry).