Clinical and scintigraphic assessment of the sphincter of Oddi dysfunction in the patients with postcholecystomy syndrome

Abstract

Introduction: The standard diagnostic for sphincter of Oddi dysfunction (SOD) is manometry, a tehnically difficult, invasive test that is frequently complicated by pancreatitis. Non-invasive hepatobiliary scintigraphy in cholecystectomised patients using a complex scoring system have been promoted as sensitive and specific alternatives. Sostre et a l proposed a score which combines quantitative and visual criteria for interpretation of hepatobiliary scans. Aim: Evaluation of different types of sphincter of Oddi dysfunction using the Scintigraphic Score Materials and methods: Thirteen patients with SOD were prospectivelly enrolled. Hepatobiliary scintigraphy was performed to all patients. Normal sphincter had scores 0-4 points, while patients with SOD had values of 5-12 points. Patients were divided into 2 goups depending on the scinthigraphic score appreciated <5 or >5 points. The evaluated criteria were algie and dyspeptic syndrome, biochemical and ultrasound parameters. Results: Four patients (score <5 points) caused equally (50%) pain with swelling and pressure character, evolution in accesses, located predominantly in the right upper quadrant and epigastrium with irradiation (double-duct type of SOD). In nine patients was assessed pain with pressure character, constant, located predominantly in the right upper quadrant (66.6%) with irradiation, associated with cholestatic syndrome (biliary type of SOD). Conclusions: In patients with scintigraphic score > 5 points was established the biliary of sphincter of Oddi dysfunction. Hepatobiliary scintigraphy scored may become the noninvasive test of choice to screen postcholecystectomy patients with suspected sphincter of Oddi dysfunction.