Diagnosing and treating Sphincter of Oddi dysfunction: a critical literature review and reevaluation.
Sphincter of Oddi dysfunction is a pathologic syndrome, without considering etiology, physiopathology, or anatomic aspects of the condition. The clinical manifestations of the syndrome may be a consequence of an "organic stenosis" of the tract or a consequence of "abnormal motility" of the sphincter. Until some years ago, the gold standard technique for studying and treating this pathologic condition was endoscopic retrograde cholangiopancreatography. Two criteria for defining patients in the Milwaukee classification are related to this procedure. The Milwaukee classification was introduced to use clinical and radiologic criteria to define patients with Sphincter of Oddi dysfunction to choose the best treatment. Subsequently, great emphasis has been placed on manometry of the sphincter performed by endoscopic cannulation. The enormous increase of cholecystectomies by means of laparoscopic technique has increased the number of patients who return to their reference-surgeon with a post-cholecystectomy pain and possible Sphincter of Oddi dysfunction. The aim of this paper is to review the literature and to evaluate an up-to-date flow chart for diagnosing and treating the syndrome by using alternative diagnostic procedures that are less invasive than endoscopic retrograde cholangiopancreatography.
Piccinni
Giuseppe
G
Department of Applications in Surgery of Innovative Technologies, University of Bari, School of Medicine, Bari, Italy. beppepiccinni@tin.it
Angrisano
Anna
A
Testini
Mario
M
Bonomo
Giovanni Martino
GM
D017115:Catheter Ablation; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003137:Common Bile Duct Diseases / Q000175:diagnosis* / Q000628:therapy*; D019160:Endosonography; D006801:Humans; D008365:Manometry; D011877:Radionuclide Imaging; D009803:Sphincter of Oddi / Q000503:physiopathology*