Clinical Trials Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2021; 9(32): 9835-9846
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9835
Evaluating the efficacy of endoscopic sphincterotomy on biliary-type sphincter of Oddi dysfunction: A retrospective clinical trial
Li-Kun Ren, Zhi-Yuan Cai, Xun Ran, Neng-Hong Yang, Xing-Zhi Li, Hao Liu, Chang-Wei Wu, Wen-Ying Zeng, Min Han
Li-Kun Ren, Zhi-Yuan Cai, Department of General Surgery, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 550025, Guizhou Province, China
Xun Ran, Neng-Hong Yang, Xing-Zhi Li, Hao Liu, Wen-Ying Zeng, Min Han, Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
Chang-Wei Wu, Department of General Surgery, The First People’s Hospital of Bijie City, Bijie 551700, Guizhou Province, China
Author contributions: Ren LK, Cai ZY, Wu CW, Li XZ and Liu H contributed to data collection, arrangement and analysis; Ren LK contributed to writing and modifying the paper; Zeng WY and Yang NH contributed to the editing guidance of the paper; All authors wrote, read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Affiliated Hospital of Guizhou Medical University Ethics Committee of Medicine. The ethics approval date is March 12, 2020.
Clinical trial registration statement: This study has been registered at Chinese Clinical Trial Registry. The registration identification number is ChiCTR2000034261.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the Consort 2010 Checklist statement, and the manuscript was prepared and revised according to the Consort Checklist (2010).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Han, MBBS, Chief Doctor, Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University, Beijing Road, Guiyang 550000, Guizhou Province, China. 409582096@qq.com
Received: May 13, 2021
Peer-review started: May 13, 2021
First decision: July 4, 2021
Revised: July 18, 2021
Accepted: September 1, 2021
Article in press: September 1, 2021
Published online: November 16, 2021
Processing time: 180 Days and 10.2 Hours
Abstract
BACKGROUND

Although endoscopic sphincterotomy (EST) has a positive therapeutic effect on biliary-type sphincter of Oddi dysfunction (SOD), some patients still have little relief after EST, which implies that other functional abdominal pain may also be present with biliary-type SOD and interfere with the diagnosis and treatment of it.

AIM

To retrospectively assess EST as a treatment for biliary-type SOD and analyze the importance of functional gastrointestinal disorder (FGID) in guiding endoscopic treatment of SOD.

METHODS

Clinical data of 79 patients with biliary-type SOD (type I and type II) treated with EST at Affiliated Hospital of Guizhou Medical University from January 2014 to January 2019 were retrospectively collected to evaluate the clinical therapeutic effect of EST. The significance of relationship between FGID and biliary-type SOD was analyzed.

RESULTS

Seventy-nine patients with biliary-type SOD received EST, including 29 type 1 patients and 50 type 2 patients. The verbal rating scale-5 (VRS-5) scores before EST were all 3 or 4 points, and the scores decreased after EST; the difference was statistically significant (P < 0.05). After EST, the serum indexes of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and total bilirubin in biliary-type SOD were significantly lower than before (P < 0.05). After EST, 67 (84.8%) and 8 (10.1%) of the 79 patients with biliary-type SOD had obviously effective (VRS-5 = 0 points) and effective treatment (VRS-5 = 1-2 points), with an overall effectiveness rate of 94.9% (75/79). There was no difference in VRS-5 scores between biliary-type SOD patients with or without FGID before EST (P > 0.05). Of 12 biliary-type SOD (with FGID) patients, 11 had abdominal pain after EST; of 67 biliary-type SOD (without FGID) patients, 0 had abdominal pain after EST. The difference was statistically significant (P <0.05). The 11 biliary-type SOD (with FGID) patients with recurrence of symptoms, the recurrence time was about half a year after the EST, and the symptoms were significantly relieved after regular medical treatment. There were 4 cases of post-endoscopic retrograde cholangiopancreatography pancreatitis (5.1%), and no cholangitis, bleeding or perforation occurred. Patients were followed up for 1 year to 5 years after EST, with an average follow-up time of 2.34 years, and there were no long-term adverse events such as sphincter of Oddi restenosis or cholangitis caused by intestinal bile reflux during the follow-up.

CONCLUSION

EST is a safe and effective treatment for SOD. For patients with type I and II SOD combined with FGID, single EST or medical treatment has limited efficacy. It is recommended that EST and medicine be combined to improve the cure rate of such patients.

Keywords: Sphincter of Oddi dysfunction; Endoscopic sphincterotomy; Functional gastrointestinal disorders; Functional dyspepsia; Functional heartburn; Irritable bowel syndrome; Curative effect

Core Tip: This article retrospectively analyzed the effect of endoscopic sphincterotomy on biliary-type sphincter of Oddi dysfunction (SOD), which increased the pain score system and the breakdown of SOD types. At the same time, functional gastrointestinal disorder and SOD are both functional diseases and often co-occur, thus affecting the endoscopic treatment of SOD. For this type of patient, this article gives appropriate guidance and treatment opinions.