Sphincter of Oddi dysfunction and pancreatitis

Table 1 Milwaukee classification of sphincter of Oddi dysfunction

1 Biliary type:

Typical biliary type pain

Liver enzymes (AST, ALT or ALP) > 2 times normal limit documented on at least 2 occasions during episodes of pain

Dilated CBD > 12 mm in diameter

Prolonged biliary drainage time (> 45 min)

Type II:

Biliary type pain and

One or two of the above criteria

Type III:

Biliary type pain only

2 Pancreatic type SOD

TypeI:

Pancreatic type pain

Amylase and/or lipase > 2 times upper normal limit on at least 2 occasions during episodes of pain

Dilated pancreatic duct (head > 6 mm, body > 5 mm)

Prolonged pancreatic drainage time (> 9 min)

Type II:

Pancreatic type pain, and

One or two of the above criteria

Type III:

Pancreatic type pain only

Table 2 Frequency of abnormal sphincter of Oddi manometry in idiopathic acute recurrent pancreatitis

Author	Year	Patient number, n	Abnormal SOM	Frequency (%)
Gregg et al[49]	1984	125	28	22
Toouli et al[50]	1985	28	14	50
Venu et al[51]	1989	116	17	15
Sherman et al[52]	1992	49	15	31
Eversman et al[16]	1999	47	34	72
Coyle et al[53]	2002	90	28	31
Kaw et al[54]	2002	126	41	33
Total		581	177	30.5

Table 3 Role of pancreatic stent insertion in prevention of post- ERCP pancreatitis; results of randomized controlled trials that included patients with SOD

Author	Year	No. of patients	Pancreatitis rate (%)
			Stent	No stent
Smithline et al[95]	1993	93	14	18	P = 0.299
Tarnasky et al[25]	1998	80	7	26	P = 0.03
Patel et al[94]	1999	36	11	33	P > 0.05
Fazel et al[35]	2003	76	5	28	P < 0.05