Management of patients with sphincter of Oddi dysfunction based on a new classification

Table 1 Clinical features of sphincter of Oddi dysfunction patients

Clinical features	n (%)
Abdominal pain
Retrosternal pain	235 (77.05)
Epigastric pain	70 (22.95)
Radiating pain	45 (14.75)
Timing of onset
After high-fat meals	241 (79.02)
After ordinary meals	21 (6.89)
Uncertain	43 (14.10)
Jaundice
With	21 (6.89)
Without	284 (93.11)
Liver enzyme levels
Abnormal	58 (19.02)
Normal	247 (80.98)
Serum amylase
Abnormal	63 (20.66)
Normal	242 (79.34)
Cholangiectasis
≥ 10 mm	289 (94.75)
< 10 mm	16 (5.25)
Pancreatic duct dilation	76 (24.92)

Table 2 Detailed classification, treatment and outcomes associated with sphincter of Oddi dysfunction

	n (%)
SOD biliary type	229/305 (75.08)
EST preferred	213/229 (93.01)
Improved	202/213 (94.83)
Good	182/202 (90.10)
Moderate	10/202 (4.95)
Poor	10/202 (4.95)
Failed	11/213 (5.16)
Exploratory laparotomy	29/229 (12.66)
Choledochointestinal anastomosis	21/29 (72.41)
Sphincter of Oddi plasty	8/29 (27.59)
Conservative treatment	8/29 (27.59)
Pancreatic type SOD	16/305 (5.25)
EPS preferred	13/16 (81.25)
Improved	10/13 (76.92)
Good	8/10 (80.00)
Moderate	2/10 (20.00)
Failed	3/13 (23.08)
Pancreatojejunal anastomosis	8/16 (50.00)
Double-duct type SOD	19/305 (6.23)
EST preferred	11/19 (57.89)
Improved	7/11 (63.64)
Failed	4/11 (36.36)
Exploratory laparotomy	12/19 (63.16)
Choledocho-, pancreato-intestinal anastomosis	7/12 (58.33)
Pancreatic head resection, choledocho-intestinal anastomosis	1/12 (8.33)
Duodenopancreatectomy	1/12 (8.33)
Biliary sphincterotomy, pancreato-intestinal anastomosis	3/12 (25.00)
Biliary-pancreatic reflux type SOD	41/305 (13.44)
EST preferred	34/41 (82.93)
Improved	20/34 (58.82)
Failed	14/34 (41.18)
Laparotomic BPD	16/41 (39.02)
Conservative treatment	5/41 (12.16)

SOD: Sphincter of Oddi dysfunction; EST: Endoscopic sphincterotomy; EPS: Endoscopic pancreatic duct sphincterotomy; BPD: Biliopancreatic diversion.

Table 3 Clinical classification and features of sphincter of Oddi dysfunction

Features	Bile duct type (type I)	Pancreatic duct type (type II)	Double-duct type (type III)	Biliary-pancreatic reflux type (type IV)
Abdominal pain	Retrosternal pain	Epigastric pain	I + II	Same as type II
Radiating pain	The central point of the back	The left back or indefinite site	I + II	Same as type II
Timing of onset	After high-fat meals	After ordinary meals	I + II	At night or in the morning
Jaundice	±	-	±	-
Liver enzyme levels	±	-	+	±
Serum amylase levels	-	+	±	+
Bile duct distension	≥ 10 mm	< 10 mm	≥ 10 mm	≥ 10 mm
Pancreatic duct distension	-	++	+	+
Anterograde cholangiography
Voiding time	> 10 min	Normal	> 10 min	Unexpected pancreatic duct visualization