Sphincter of Oddi dysfunction after successful gallstone lithotripsy (postlithotripsy syndrome): manometric data and results of endoscopic sphincterotomy.

Abstract

After successful gallstone lithotripsy, biliary pain recurs in about one third of patients. However, gallstone recurrence can be shown in only 40-60% of these patients. Therefore, other causes, such as sphincter of Oddi dysfunction (SOD), may be suspected. Twenty-two consecutive patients with recurrent biliary pain after successful gallstone lithotripsy without evidence of gallstone recurrence at ultrasonography were enrolled. Liver tests were elevated in 13 patients and ERC showed a dilated bile duct in nine. All 22 patients underwent sphincter of Oddi (SO) manometry, bile sample analysis for microlithiasis, endoscopic sphincterotomy (ES), and bile duct exploration with a Dormia basket. Thereafter, the patients were clinically followed at bimonthly intervals. SO manometry revealed SOD in 15/22 patients. This was more often the case in patients with initially larger (>2 cm) or multiple stones than after lithotripsy for solitary small stones (P < 0.01). Microlithiasis was detected in one patient, another patient had small biliary calculi at bile duct exploration (both without SOD). After ES, 14/15 patients with biliary SOD but none of the five without SOD improved (median follow-up: two years; P < 0.01). The one patient with CBD stones became symptom-free after ES, while the patient with microlithiasis improved after additional cholecystectomy only. Overall, ES proved to be the adequate therapy in 15/22 patients (68%, median follow-up: 22 months). After gallstone lithotripsy, SOD is found in about two thirds of patients with recurrent symptoms but without gallstone recurrence. In this group CBD stones or microlithiasis are rare. Therefore, SOD has to be suspected in this situation and ES gives favorable results, even when performed on a clinical basis only (without SO manometry).