Medical treatment for sphincter of oddi dysfunction: Can it replace endoscopic sphincterotomy?

Table 1 Patient’s characteristics n (%)

Age, mean ± SD, yr	50.5 ± 12
Sex, M/F	2/57
Symptoms
Biliary	47 (79.6)
Pancreatic	9 (15.2)
Biliopancreatic	3 (5)
Occurrence of painful episodes
Once a week	9 (15.8)
Once a month	20 (35.1)
Every 3 mo	9 (15.8)
Every 6 mo	3 (5.3)
Once a year	7 (12.3)
Dilatation of biliary or pancreatic ducts
(bile duct > 12 mm; pancreatic duct > 4 mm)
Main biliary duct dilatation	29 (49.1)
Main pancreatic duct dilatation	1 (1.7)
Milwaukee classification repartition
Type 1	11 (18.6)
Type 2	34 (57.6)
Type 3	14 (23.7)
Initial elevation of laboratory data	34 (57.6)
Lengthening of the isotopic transit time	32 (54.2)

Table 2 One-year outcome after medical treatment n (%)

Global effect
Complete or partial	38 (64.3)
Poor	21 (35)	P < 0.05
Complete or partial effect according the Milwaukee group
Type 1	5 (45)
Type 2	23 (67)	P = 0.31
Type 3	10 (71)
Complete or partial effect according to the increase of HDTT
With prolongation of HDTT	21 (55.3)
Without prolongation of HDTT	17 (44.7)	P = 0.77

HDTT: Hile to duodenum transit time.

Table 3 Results of the endoscopic treatment (n = 14), (%)

Time between the beginning of medical therapy
and endoscopic treatment (mo)	12.2 ± 1.5
Patients concerned
Patients with poor response to medical treatment	12 (57.1)
Patients with a partial response	2 (25)
Indication according to Milwaukee group
Type 1	4 (36)
Type 2	9 (27)
Type 3	1 (7)
Results according to Milwaukee group
Type 1	3/4 (75)
Type 2	6/9 (66)
Type 3	0/1 (0)

Table 4 Results after intermediate follow-up (29.8 ± 3 mo) n (%)

Rate of improvement
Total rate	37 (62.7)
Without endoscopic sphincterotomy	28 (62)	P = 0.88
With endoscopic sphincterotomy	9 (64.2)
According to initial lengthening of HDTT
With lengthening	19 (59.4)
Without lengthening	18 (66.7)	P = 0.59
According to the Milwaukee group
Type 1	6/11 (54.5)
Type 2	23/34 (67.6)	P = 0.75
Type 3	8/14 (57.1)

HDTT: Hile to duodenum transit time.