Dyskinesia of sphincter of Oddi
ICD-10 K83.4 · ICD-11 DC14.2

Treatment of Biliary-Type Pain When Biliary Sphincterotomy Has Not Achieved Long-Term Relief

This protocol covers patients with dyskinesia of the sphincter of Oddi who present with recurrent biliary pain supported by one or two objective criteria, and in whom a prior biliary sphincterotomy performed during ERCP has failed to achieve lasting pain relief.

Clinical Scenario

Biliary pain is present alongside 1 or 2 of the following objective criteria:

Previous Intervention: Goal Not Met

Biliary sphincterotomy (performed during ERCP) was the prior step. This protocol applies when that procedure has not achieved its goal — long-term relief of biliary-type pain — and further management is required.

Next-Step Treatment Approach

The approach at this stage is pharmacologic, involving agents that act on sphincter muscle function. Several specific drug options are considered depending on the clinical picture.

Full agent selection, sequencing, and dosing are in the complete protocol below.

Treatment Goals

Reduction in the number of biliary pain episodes and resolution or meaningful improvement of biliary-type pain.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.3390/jcm12144802

Biliary pain and 1 or 2 out of the 3 above criteria.

Calcium-channel blockers (nifedipine, nicardipine) are known smooth muscle relaxants that potentially could decrease the basal pressure of the SO.

Nifedipine has been explored in the SOD treatment in the randomized controlled trial [53] including 28 patients with elevated SO basal pressure without abnormal phasic wave contractions on SOM.

Compared with patients in the placebo group, patients in the nifedipine group had a significantly lower number of pain episodes and emergency room visits, and a decreased use of analgesics.

View source ↗