Endoscopic bile duct stent placement as a predictor of outcome following endoscopic sphincterotomy in patients with suspected sphincter of Oddi dysfunction

Abstract

Objectives: To determine whether symptomatic improvement following placement of endoscopic stent across the biliary sphincter could predict the longer-term clinical outcome after endoscopic sphincterotomy (ES).

Methods: Twenty-three post-cholecystectomy patients with suspected sphincter of Oddi dysfunction underwent, sequentially, sphincter of Oddi manometry, endoscopic stent placement, ES, and follow-up for a further 6-12 months.

Results: Eight (35%) patients either did not respond (n = 5), did not tolerate the stent (n = 1) or relapsed during stenting (n = 2). Only the patient who did not tolerate the stent from the outset (12%) improved after ES. Of five patients who responded to stenting and had ES within 8 weeks, only two (40%) remained asymptomatic. In contrast, of 10 patients who were pain-free during 12-14 weeks of stenting, nine (90%) continued to be asymptomatic after ES. All seven patients with an elevated sphincter of Oddi pressure responded to stenting and six benefited from sphincter ablation. Five (31%) of 16 patients who had normal sphincter pressure and had improvement after 12-14 weeks of stenting remained free from pain following ES. ES resulted in long-term freedom from pain in 12 of the 23 patients: six of the seven patients with elevated sphincter of Oddi pressure and six of the 16 subjects with normal manometry (P < 0.05).

Conclusion: Freedom from symptoms during at least 12 weeks of stenting predicted a favourable outcome after ES, irrespective of sphincter of Oddi pressure. Patients who failed to improve or showed improvement only with short-term stenting were less likely to benefit.