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

Dyskinesia of Sphincter of Oddi: When Biliary Sphincterotomy Did Not Achieve Long-Term Relief of Biliary-Type Pain

This protocol applies to patients with Type 1 biliary sphincter of Oddi dysfunction who have undergone biliary sphincterotomy during ERCP but continue to experience biliary-type pain without achieving long-term relief.

Diagnostic Criteria

The patient presents with biliary pain fulfilling all three of the following objective findings:

Prior Treatment Did Not Meet Its Goal

Previous intervention: Biliary sphincterotomy performed during ERCP.
Goal not reached: Long-term relief of biliary-type pain.

This protocol defines the recommended next clinical step when that goal has not been met.

Next-Line Treatment Approach

When biliary sphincterotomy has not resolved biliary-type pain, management shifts to pharmacologic treatment — including an agent from the class of tricyclic antidepressants. The complete options, selection criteria, and regimen details are available in the full protocol.

Dosages, full algorithm, and all treatment options are not shown here.

Treatment Target

Resolution or improvement of biliary-type pain.

Instant Access to Structured Evidence-Based Regimens

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 ***.

Pharmacological treatments included a combination of nitrates, tricyclic antidepressants (amitriptyline) and/or analgesics, and patients were followed for a median of 15 months.

At follow-up, 15.3% of patients reported complete symptom resolution, 59.3% improvement, 22% unchanged symptoms, and 3.4% deterioration.

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