Biliary dyskinesia overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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.
CT
CT scan is not helpful in gallbladder or biliary diseases.
Ultrasound
Ultrasound is required in these patients in order to exclude structural conditions such as gallstone disease or cancer. Ultrasound may be used in order to diagnose sphincter of oddi (SOD) disorders by measuring the common bile duct (CBD) diameter.
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. Noninvasive procedures that may be used to evaluate and diagnose SOD disorders are: ultrasound, HIDA scan, and MRCP.
Other Diagnostic Studies
ERCP and Sphincter of Oddi (SOD) manometry may be used to rule out functional biliary sphincter of Oddi (SOD) disorder in patients who have had a cholecystectomy.[1] Although SOD manometry is the diagnostic tool for evaluating SOD disorders, it is an invasive procedure and has risk for complications.
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 SOD contraction.
Surgery
Cost-Effectiveness of Therapy
Future or Investigational Therapies
References
- ↑ 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.