Biliary dyskinesia overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]
Overview
Biliary dyskinesia is a failure of proper movement of the sphincter of Oddi.
Failure of the biliary sphincter can be distinguished from the pancreatic sphincter.
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
The initial laboratory work-up should include: liver function tests (AST, ALT and, total bilirubin), amylase, and lipase.[1]
CT
CT scan is not helpful in gallbladder or biliary diseases.[1]
Ultrasound
Ultrasound is required in these patients in order to exclude structural conditions such as gallstone disease or cancer.[2] Ultrasound may be used in order to diagnose sphincter of oddi disorders (SOD) by measuring the common bile duct (CBD) diameter.[3]
Other Imaging Findings
Hepatobiliary iminodiacetic acid (HIDA) with an abnormal gallbladder ejection fraction (<40%) is a supportive criteria for diagnosing biliary dyskinesia but is not required for the diagnosis anymore.[1][4] Noninvasive procedures that may be used to evaluate and diagnose sphincter of Oddi disorders (SOD) are: ultrasound, HIDA scan, and MRCP.[3]
Other Diagnostic Studies
ERCP and sphincter of Oddi manometry may be used to rule out functional biliary sphincter of Oddi disorder (SOD) in patients who have had a cholecystectomy.[1] Although sphincter of Oddi manometry is the diagnostic tool for evaluating sphincter of Oddi disorders (SOD), it is an invasive procedure and has risk for complications.[2]
Treatment
Medical Therapy
Medical therapy mostly includes of symptomatic treatment of abdominal pain and IV opiates are the drug of choice, although some studies have suggested that opiates cause sphincter of Oddi contraction.[2][5]
Surgery
Laparoscopic cholecystectomy is used to treat biliary dyskinesia. Endoscopic biliary sphincterotomy is performed in patients with sphincter of Oddi disorder (SOD) diagnosed by manometry.[2]
Cost-Effectiveness of Therapy
Future or Investigational Therapies
References
- ↑ 1.0 1.1 1.2 1.3 Clark CJ (2019). "An Update on Biliary Dyskinesia". Surg Clin North Am. 99 (2): 203–214. doi:10.1016/j.suc.2018.11.004. PMID 30846030.
- ↑ 2.0 2.1 2.2 2.3 Wilkins T, Agabin E, Varghese J, Talukder A (2017). "Gallbladder Dysfunction: Cholecystitis, Choledocholithiasis, Cholangitis, and Biliary Dyskinesia". Prim Care. 44 (4): 575–597. doi:10.1016/j.pop.2017.07.002. PMID 29132521.
- ↑ 3.0 3.1 Sgouros SN, Pereira SP (2006). "Systematic review: sphincter of Oddi dysfunction--non-invasive diagnostic methods and long-term outcome after endoscopic sphincterotomy". Aliment Pharmacol Ther. 24 (2): 237–46. doi:10.1111/j.1365-2036.2006.02971.x. PMID 16842450.
- ↑ Cotton PB, Elta GH, Carter CR, Pasricha PJ, Corazziari ES (2016). "Rome IV. Gallbladder and Sphincter of Oddi Disorders". Gastroenterology. doi:10.1053/j.gastro.2016.02.033. PMID 27144629.
- ↑ Behar J, Corazziari E, Guelrud M, Hogan W, Sherman S, Toouli J (2006). "Functional gallbladder and sphincter of oddi disorders". Gastroenterology. 130 (5): 1498–509. doi:10.1053/j.gastro.2005.11.063. PMID 16678563.