Key issues in sphincter of Oddi dysfunction.
SOD is a challenging condition that is difficult to diagnose and treat. The high failure rate of endoscopic and surgical treatment reflects the difficulties in establishing accurate diagnosis and the lack of specific objective criteria by which appropriate therapy could be determined. In general, sphincter ablation should be offered for type I patients. An initial trial of medical therapy is appropriate for type II patients with mild-to-moderate symptoms and for all type III patients. SOM is highly recommended for type II patients and is mandatory for all type III patients if sphincter ablation is contemplated. Other causes of abdominal pain such as chronic pancreatitis or functional disorders should be considered in patients not benefiting from sphincter ablation. All procedures on the sphincter should be undertaken with caution after meticulous investigation, and patient selection should be based on strict objective criteria.
Medical University of South Carolina Digestive Disease Center, Charleston 29425, USA. svaradarajulu@yahoo.com
Shyam
S
Varadarajulu
Robert
R
Hawes
D003137:Common Bile Duct Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008365:Manometry / Q000009:adverse effects / Q000379:methods; D010195:Pancreatitis / Q000150:complications; D009803:Sphincter of Oddi / Q000503:physiopathology* / Q000601:surgery; D016717:Sphincterotomy, Endoscopic / Q000379:methods