Treatment of Dyskinesia of Sphincter of Oddi with Biliary Pain, Elevated Aminotransferases, and Common Bile Duct Dilation on ERCP
This protocol targets a specific, objectively defined presentation of Dyskinesia of sphincter of Oddi: biliary-type pain accompanied by elevated liver enzymes, common bile duct dilation on imaging, and impaired biliary drainage demonstrated on ERCP.
Clinical Scenario
The protocol applies when biliary pain is present alongside all three of the following findings:
- Serum aminotransferases elevated above 2× the upper limit of normal on 2 or more occasions
- Common bile duct dilation >10 mm on ultrasound, or >12 mm on ERCP
- Delayed drainage of contrast from the common bile duct on ERCP
Treatment Approach
An endoscopic intervention performed during ERCP is the primary approach in this setting. High-level evidence supports this non-pharmacologic strategy for patients presenting with this combination of objective findings. The full structured regimen and decision pathway are available via the protocol below.
Clinical Goal
Long-term relief of biliary-type pain.
References
DOI: 10.3390/jcm12144802
- Biliary pain and all 3 of the following:
- Serum aminotransferases: elevation of serum-aminotransferases above 2 times the upper limit on 2 or more occasions.
- CBD dilation: above 10 mm on US or above 12 mm on ERCP.
- Delayed drainage of contrast from the CBD on ERCP.
- Endoscopic sphincterotomy is the most commonly used non-pharmacologic treatment for SOD for patients with type 1 and 2 SOD.
- The management of SOD most often involves non-pharmacologic treatment, and high-level evidence supports sphincterotomy in type 1 and 2 SOD.
- Two randomized controlled trials, including a sphincterotomy group and a control group receiving sham intervention, showed that patients with abnormally elevated basal pressure showed over 90% long-term relief in symptoms related to biliary-type pain when undergoing sphincterotomy of the biliary SO.
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