Functional Gall-Bladder and Sphincter of Oddi Disorders

Functional disorders of the biliary tree include gallbladder dyskinesia and Sphincter of Oddi dysfunction. Both present as recurrent epigastric and right upper quadrant pain reminiscent of biliary colic, in the absence of biliary stones. Gallbladder dyskinesia is defined by an ejection fraction below 35% following slow infusion of a weight based dose of CCK. The pathogenesis of pain is unclear; never-the-less, cholecystectomy is the therapy of choice. Data are mixed as to whether subnormal gallbladder emptying predicts improvement following surgery in patients with pain of suspected biliary origin. Sphincter of Oddi dysfunction is defined as pain related to fixed or dynamic obstruction of the biliary or pancreatic ducts. It is commonly characterized by whether it involves the biliary and/or the pancreatic sphincter and by the presence or absence of objective abnormalities of bile duct or pancreatic duct caliber or by abnormalities of serum liver or pancreatic enzymes during pain. Diagnosis is classically made by manometric identification of basal sphincter pressures over 40 mm Hg during endoscopic retrograde cholangiopancreatography (ERCP). SOD is treated by endoscopic sphincterotomy of the hypertensive sphincter(s). Prophylactic pancreatic stent placement is employed to reduce the risk of procedure induced pancreatitis.