Sphincter of Oddi Dysfunction After Gastric Bypass: Surgical or Endoscopic Therapy?

Patrick B. Schwartz, Jeffrey J. Easler, William P. Lancaster, Michael G. House, Nicholas J. Zyromski, C. Max Schmidt, Attila Nakeeb, Eugene P. Ceppa

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: Management of Sphincter of Oddi Dysfunction (SOD) requires advanced techniques (endoscopic retrograde cholangiopancreatography via gastrostomy [GERCP]) after Roux-en-Y gastric bypass (RYGB) for obesity. Transduodenal sphincteroplasty (TS) is also performed yet carries the risks of surgery. We hypothesized that TS would have increased morbidity and mortality but provide a more durable remission of symptoms. Methods: All patients between 2005 and 2016 with RYGB for obesity undergoing endoscopic or surgical management for type I or II SOD were included in the study. Patients with type III SOD, or who underwent RYGB for nonobesity indications, were excluded. Results: Thirty-eight patients were identified. GERCP was initially performed in 17 patients, whereas TS was performed in 21. Thirty-day mortality was 0% in our cohort, and 30-d morbidity was similar between GERCP and TS (29% versus 10%; P = 0.207). Resolution of symptoms after initial therapy was seen in 41% of GERCP (7/17) and 67% of TS (14/21) (P = 0.190), respectively, and overall after 35% (8/23) and 64% (16/24) of procedures performed (P = 0.042). Symptom resolution, as defined by the median ratio of days of total remission by total days of observed follow-up, was shorter after initial and all interventions with GERCP compared with TS (0.67 versus 1.00, P = 0.036 and 0.52 versus 1.00, P = 0.028, respectively). Conclusions: Endoscopic and surgical treatment of SOD had similar morbidity and mortality. However, treatment success and duration of remission was higher in those treated with surgery.

Original languageEnglish (US)
Pages (from-to)41-47
Number of pages7
JournalJournal of Surgical Research
Volume238
DOIs
StatePublished - Jun 2019

Keywords

  • ERCP
  • Endoscopy
  • Obesity
  • Roux-en-Y
  • Sphincteroplasty

ASJC Scopus subject areas

  • Surgery

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