Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2015; 21(19): 5755-5761
Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.5755
Sphincter of Oddi dysfunction Type III: New studies suggest new approaches are needed
C Mel Wilcox
C Mel Wilcox, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Basil I Hirschowitz Endoscopic Center of Excellence, Birmingham, AL 35294-0113, United States
Author contributions: Wilcox CM solely contributed to this paper.
Conflict-of-interest: Wilcox CM was involved in the design and conduct of the evaluating predictors in sphincter of Oddi dysfunction study. Wilcox CM have no conflicting interests related to any commercial, personal, political, intellectual, or religious interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: C Mel Wilcox, MD, MSPH, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Basil I Hirschowitz Endoscopic Center of Excellence, 1720 2nd Ave., South BDB 380, Birmingham, AL 35294-0113, United States. melw@uab.edu
Telephone: +1-205-9754958 Fax: +1-205-9348493
Received: December 31, 2014
Peer-review started: January 1, 2015
First decision: February 10, 2015
Revised: March 12, 2015
Accepted: April 17, 2015
Article in press: April 17, 2015
Published online: May 21, 2015
Processing time: 140 Days and 5.2 Hours
Abstract

Sphincter of Oddi dysfunction (SOD) has been classified into three types based upon the presence or absence of objective findings including liver test abnormalities and bile duct dilatation. Type III is the most controversial and is classified as biliary type pain in the absence of any these objective findings. Many prior studies have shown that the clinical response to endoscopic therapy is higher based upon the presence of these objective criteria. However, there has been variable correlation of the manometry findings to outcome after endoscopic therapy. Nevertheless, manometry and sphincterotomy has been recommended for Type III patients given the overall response rate of 33%, although the reported response rates are highly variable. However, all of the prior data was non-blinded and non-randomized with variable follow-up. The evaluating predictors in SOD study - a prospective randomized blinded sham controlled one year outcome study showed no correlation between manometric findings and outcome after sphincterotomy. Furthermore, patients receiving sham therapy had a statistically significantly better outcome than those undergoing biliary or dual sphincterotomy. This study calls into question the whole concept of SOD Type III and, based upon prior physiologic studies, one can suggest that SOD Type III likely represents a right upper quadrant functional abdominal pain syndrome and should be treated as such.

Keywords: Abdominal pain; Sphincter of Oddi dysfunction; Manometry; Sphincterotomy

Core tip: Prior observations suggest that biliary sphincterotomy may be of benefit in patients with sphincter of Oddi dysfunction (SOD) Type III who have biliary type pain but no objective findings of bile duct obstruction. The prospective randomized blinded sham controlled trial termed evaluating predictors in SOD demonstrated no correlation between manometry and outcome and furthermore showed that patients receiving sham therapy had a better outcome than those receiving either biliary or dual sphincterotomy. Until other studies are available, patients with biliary type pain in the absence of objective findings should not routinely undergo endoscopic retrograde cholangiopancreatography and do not benefit from sphincterotomy.