Sphincter of Oddi

BackgroundThe paucity of controlled data for the treatment of most biliary sphincter of Oddi disorder (SOD) types and the incomplete response to therapy seen in clinical practice and several trials has generated controversy as to the best course of management of these patients. In this observational study we aimed to assess the outcome of patients with biliary SOD managed without sphincter of Oddi manometry.MethodsFifty-nine patients with biliary SOD (14% type I, 51% type II, 35% type III) were prospectively enrolled. All patients with a dilated common bile duct were offered endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy whereas all others were offered medical treatment alone. Patients were followed up for a median of 15 months and were assessed clinically for response to treatment.ResultsAt follow-up 15.3% of patients reported complete symptom resolution, 59.3% improvement, 22% unchanged symptoms, and 3.4% deterioration. Fifty-one percent experienced symptom resolution/improvement on medical treatment only, 12% after sphincterotomy, and 10% after both medical treatment/sphincterotomy. Twenty percent experienced at least one recurrence of symptoms after initial response to medical and/or endoscopic treatment. Fifty ERCP procedures were performed in 24 patients with an 18% complication rate (16% post-ERCP pancreatitis). The majority of complications occurred in the first ERCP these patients had. Most complications were mild and treated conservatively. Age, gender, comorbidity, SOD type, dilated common bile duct, presence of intact gallbladder, or opiate use were not related to the effect of treatment at the end of follow-up (p > 0.05 for all).ConclusionsPatients with biliary SOD may be managed with a combination of endoscopic sphincterotomy (performed in those with dilated common bile duct) and medical therapy without manometry. The results of this approach with regards to symptomatic relief and ERCP complication rate are comparable to those previously published in the literature in cohorts of patients assessed by manometry.

ObjectiveBiliary calculi, a common benign disease of the gastrointestinal tract, are affected by multiple factors, including diet, lifestyle, living environment, and personal and genetic background. Its occurrence is believed to be related to a change in biliary microbiota. Approximately 10%-20% of symptomatic patients with cholecystolithiasis have choledocholithiasis, resulting in infection, abdominal pain, jaundice, and biliary pancreatitis. This study aimed to determine whether a dysfunction in the sphincter of Oddi, which controls the outflow of bile and separates the bile duct from the intestine, leads to a change in biliary microbiota and the occurrence of biliary calculi.MethodsForty patients with cholecystolithiasis and choledocholithiasis were prospectively recruited. Bile specimens were obtained, and biliary pressure was measured during and after surgery. The collected specimens were analyzed with 16S rRNA gene to characterize the biliary microbiota. The risk factors of common bile duct calculi were analyzed numerically combined with the pressure in the sphincter of Oddi.ResultsDifferent biliary microbiota were found in all cases. Patients with sphincter of Oddi dysfunction had significantly increased biliary microbiota as well as significantly higher level of systemic inflammation than patients with normal sphincter of Oddi.ConclusionsThe systemic inflammatory response of patients with sphincter of Oddi dysfunction is more severe, and their microbial community significantly differs from that of patients with normal sphincter of Oddi, which makes biliary tract infection more likely; furthermore, the biliary tract of patients with sphincter of Oddi dysfunction has more gallstone-related bacterial communities.

Clinically, acupuncture affects the motility of the extrahepatic biliary tract, but the underlining mechanisms are still unknown. We applied manual acupuncture (MA) and electrical acupuncture (EA) separately at acupoints Tianshu (ST25), Qimen (LR14), Yanglingquan (GB34), and Yidan (CO11) in forty guinea pigs (4 groups) with or without atropinization under anesthesia while Sphincter of Oddi (SO) myoelectric activities and gallbladder pressure were monitored. In both MA and EA groups, stimulation at ST25 or LR14 significantly increased the frequency and amplitude of SO myoelectrical activities and simultaneously decreased the gallbladder pressure as compared to the pre-MA and pre-EA (P 0.05), although significant myoelectricity increases were still inducible with MA or EA stimulation at CO11 (P < 0.05). In summary, acupuncture has bi-directional effects to gallbladder pressure and SO function, which probably due to autonomic reflex and somatovisceral interactions.

BackgroundSphincter of Oddi dysfunction (SOD) can cause unexplained biliary pain and idiopathic pancreatitis. Although Rome IV criteria recommend sphincter of Oddi manometry (SOM) for diagnosis, SOM is invasive and carries pancreatitis risk. We hypothesized that cine-dynamic magnetic resonance cholangiopancreatography (MRCP) could non-invasively visualize bile and pancreatic juice flow, enabling functional papillary assessment.MethodsIn this prospective observational study, 40 participants were enrolled, and 29 were included in the final analysis after excluding 11 participants who did not meet the Rome IV criteria (10 healthy controls, 7 with suspected biliary-type SOD [BSOD], and 12 with suspected pancreatic-type SOD [PSOD]). Cine-dynamic MRCP was performed with 20 sequential frames over 5 min. Two quantitative indices were assessed: flow frequency and secretion grade (distance traveled by bile or pancreatic juice).ResultsBile flow frequency and secretion grade were significantly lower in both BSOD and PSOD than in controls: frequency (median [range], 13.5 [6-19] in controls vs. 2.0 [1-17] in BSOD, p = 0.006; vs. 8.0 [3-14] in PSOD, p = 0.008) and secretion grade (1.6 [0.3-2.05] in controls vs. 0.2 [0.1-1.3] in BSOD, p = 0.001; vs. 0.5 [0.15-1.75] in PSOD, p = 0.03). Pancreatic juice flow showed no significant difference between BSOD and controls but was significantly reduced in PSOD: frequency (16 [14-19] in controls vs. 9.5 [4-17] in PSOD, p ConclusionsCine-dynamic MRCP enables non-invasive visualization and quantification of bile and pancreatic juice flow, providing functional assessment of the sphincter of Oddi.