Outcome of endoscopic sphincterotomy in post cholecistectomy patients with sphincter of Oddi dysfunction as predicted by manometry and quantitative choledochoscintigraphy

Background: Sphincter of Oddi dysfunction is diagnosed at manometry and, after cholecystectomy,non-invasively at quantitative choledochoscintigraphy. Patients may benefit from endoscopic sphincterotomy.Aims: The aim of this study was to assess the usefulness of choledochoscintigraphy compared withmanometry in predicting outcome of sphincterotomy in post cholecystectomy patients with sphincter ofOddi dysfunction.Patients and methods: Thirty patients with biliary-type pain complying with the Rome diagnostic criteriaof sphincter of Oddi dysfunction and belonging to biliary group I and II were subjected to clinicalevaluation, choledochoscintigraphic assessment of the hepatic hilum-duodenum transit time,endoscopic retrograde cholangiopancreatography, and perendoscopic manometry. Twenty twobiliary group I and II patients with prolonged hepatic hilum-duodenum transit times were invited toundergo sphincterotomy. Fourteen patients underwent sphincterotomy; eight refused. Clinical and scintigraphicassessments were performed at follow up.Results: Hepatic hilum-duodenum transit time was delayed in all patients with manometric evidence ofsphincter of Oddi dysfunction, in all biliary group I patients and in 64% of biliary group II patients. Atfollow up, all patients who underwent sphincterotomy were symptom free and hepatic hilum-duodenumtransit time had either normalised or significantly improved. A favourable post sphincterotomy outcomewas predicted in 93% of cases at choledochoscintigraphy and in 57% at manometry.Conclusions: Quantitative choledochoscintigraphy is a useful and non-invasive test to diagnosesphincter of Oddi dysfunction as well as a reliable predictor of sphincterotomy outcome in postcholecystectomy biliary group I and II patients, irrespective of clinical classification and manometricfindings.