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Treatment of Sphincter of Oddi Dysfunction

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Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Abstract

Sphincter of Oddi dysfunction (SOD) is a benign obstructive disorder of the biliary and/or pancreatic ductal system at the level of the sphincter of Oddi due to contractile dysfunction of the smooth muscles or narrowing from scar tissue. As per the Rome IV, biliary SOD has been reclassified into benign papillary stenosis, functional biliary sphincter disorder, and functional biliary abdominal pain and pancreatic SOD into functional pancreatic sphincter disorder. Benign papillary stenosis is primarily managed with a biliary endoscopic sphincterotomy (ES) and functional biliary sphincter disorder managed with a biliary sphincter manometry (SOM) to predict response to a biliary ES when expertise for SOM is available and, if not, managed with an empiric biliary ES. Functional biliary abdominal pain is managed medically as functional abdominal pain with antispasmodics and tricyclic antidepressants. Management of functional pancreatic sphincter disorder has some controversy with some authorities recommending initially an empiric biliary ES while others suggesting pancreatic SOM and dual biliary and pancreatic ES with the strategy limited by local expertise to perform SOM. It is appropriate to try smooth muscle relaxants and neuropathic pain modulators, but efficacy is limited. Surgery is currently limited to patients with debilitating symptoms refractory to endoscopic therapy or if endoscopic therapy is not feasible due to altered anatomy.

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  1. Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Aditya Gutta & Glen Lehman

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  1. Aditya Gutta
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  2. Glen Lehman
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  1. Division of Gastroenterology and Gastrointestinal Endoscopy IRCCS, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA

    Michael B. Wallace

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  1. Gastrointestinal Endoscopy Unit, Vita‐Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

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Gutta, A., Lehman, G. (2022). Treatment of Sphincter of Oddi Dysfunction. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-56993-8_76

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