SOD is a definite cause for pancreaticobiliary pain. There is no role for ERCP alone in the evaluation of patients with pancreaticobiliary pain in the absence of objective evidence suggesting biliary or pancreatic disease. The value of noninvasive radiologic imaging tests to select patients for SOM and as a predictor of outcome from sphincter ablation is uncertain and warrants further study. SOM should be considered the reference standard for evaluating Type II and Type III patients for SOD because the results of this study best predict response to sphincter ablation. If SOD is suspected in a Type III or mild to moderate pain level Type II patient, medical therapy should generally be tried. If medical therapy fails or is bypassed, ERCP and manometric evaluation are recommended. Sphincter ablation is generally warranted in symptomatic Type I patients and Types II and III patients with abnormal manometry. The symptom relief rate varies from 55% to 95%, depending on the patient presentation, patient selection, and completeness of sphincter ablation. Assessment and treatment of the pancreatic sphincter appear necessary to achieve optimal outcome. SOD patients have relatively high complication rates after invasive evaluation and therapy. Thorough review of the risk-benefit ratio with individual patients is mandatory. Patients with suspected SOD are best evaluated in centers with an interest in this disease and skills in advanced ERCP techniques.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging