Letter to the Editor

Diagnostic challenge of Sphincter of oddi dysfunction in postcholecystectomy pain syndromes

Authors: V Vijayakumar, MD, E G. Briscoe, BS, CNMT, ARRT

Abstract

Persistent abdominal pain after cholecystectomy is not uncommon. An increasing number of laparoscopic cholecystectomies are contributing to the growing number of patients with postcholecystectomy recurrent pain syndromes. Sphincter of oddi dysfunction (SOD) is one of the causes for this entity. However, diagnosing SOD is often difficult.1–4 Sphincter of oddi manometry (SOM) is the gold standard. Endoscopic retrograde cholangiopancreatography (ERCP) is another invasive procedure commonly used to diagnose this condition. Since these two modalities are invasive and are associated with complications, simple noninvasive imaging techniques are needed for the diagnosis of SOD, such as the quantitative hepatobiliary study (QHBS) by Sostre et al,1 utilizing cholecystokinin and a scoring system.

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References

1.Sostre S, Kalloo AN, Spiegler EJ, et al. A Noninvasive test of sphincter ofoddi dysfunction in post-cholecystectomy patients: The Scintigraphic score. JNucl Med 1992;33:1216–1224.
 
2.Ganatra RH, Rees J, Kerwat R, et al. Sphincter of Oddi dyskinesia: Role of cholecystokinin cholescintigraphy. Nucl Med Commun 2000;21:211–212.
 
3.Piccinni G, Angrisano A, Testini M, et al. Diagnosing and Treating Sphincter of Oddi Dysfunction: A Critical Literature Review and Reevaluation. J Clin Gastroenterol 2004;38:350–359.
 
4.Craig AG, Peter D, Sac cone GT, et al. Scintigraphy versus manometry in patients with suspected biliary sphincter of Oddi dysfunction. Gut 2003;52:352–357.