Sphincterotomy for Sphincter of Oddi Dysfunction

Sphincter of Oddi dysfunction (SOD) is a proposed but controversial cause of idiopathic recurrent acute pancreatitis or chronic biliary-type pain that lacks an identifiable anatomic source. Clinical features thought to predict SOD are a dilated bile duct and elevated liver enzymes, but overlying somatization and opioid use have complicated interpretation of prior studies. Many clinicians doubt that SOD exists.

Investigators from 14 U.S. centers prospectively studied 213 patients with suspected SOD who underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy. Most patients had chronic abdominal pain, and half had at least one recent episode of idiopathic pancreatitis. The primary endpoint — “much” or “very much” imp…