Clinical outcomes and predictors of response after endoscopic treatment for sphincter of Oddi dysfunction (SOD)

Purpose: To better evaluate long-term outcome and determine predictors of response after endoscopic treatment for SOD. Methods: All patients (pts) with no history of prior endotherapy, who underwent sphincterotomy for SOD during a 30 month period were surveyed by mail or confidential telephone interview using a standardized questionnaire. Patients were asked to rate change in, and current global condition (Likert Scale), need for analgesia and medical attention frequency and severity of pain before and after treatment. Results: 136 (90%) pts (123 female, mean age 48 years, 83% prior cholecystectomy) could be contacted. Once pt had died (unrelated condition). Pt grouping according to Geenan-Hogan (GH) classification: Type I: 4%, Type II: 27%, Typelll: 69%. Mean duration of symptoms prior to treatment: 41 months (mos). Mean follow-up: 17 mos (range 6-46 mos). The initial endoscopic therapy was biliary sphincterotomy (BS) only in 117 (86%) pts, 25% required subsequent pancreatic sphincterotomy (PS) due to residual pancreatic sphincter hypertension (median 2 mos, range 0.5-34mos) and 5% required repeat BS due to restenosis (median 1 mo, range 0.5-1mo). Combined BS + PS was initial therapy in 15(11%) pts, 4 (27%) of these pts required subsequent PS due to restenosis (median 2.5 mos, range 0.5-3mos). PS alone was initial therapy in 3 pts. Global Condition Pain Frequency Pain Severity Before poor-terrible 83% continuous 66% 8.6 ± 1.9 SD good-excellent 2% monthly-none 10% After (now) poor-terrible 16% continuous 24% 3.6 ± 3.1 SD good-excellent 56% monthly-none 60% (p<.0001) The mean weekly number of analgesics reduced from 13.0 ± 12.2 SD 6 mos before treatment to 6.9 ± 12.2 SD 6 mos after treatment (p<0.001). Marked-somewhat improvement in global condition after treatment occurred in 99/111 (89%) of pts with either normal pancreatography or mild chronic pancreatitis (CP), as denned by Cambridge criteria, compared with 12/23 (52%) of pts with moderate/severe CP (p = 0.0001). Marked-somewhat improvement in global condition occurred in 79% GH type I, 88% GH type II and 80% GH type III (n.s.). Immediate post therapy pancreatitis occurred after 5.8% of procedures, (56% were mild severity, 37% moderate severity and 10% severe); there was one endoscopic perforation. Conclusion: (1) Clinical outcomes are overall favorable after endoscopic therapy for SOD with an associated reduction in analgesic use and acceptable complication rate. (2) There were no differences in outcome when stratified according to GH type. (3) Responses were better in patients with either normal pancreatography or only mild CP. (4) About one third of pts required repeat early endoscopic therapy within 3 mos.