Sphincter of Oddi Dysfunction: A Survey of Current Practice in USA

Background and aims: The role of sphincter of Oddi dysfunction (SOD) and sphincter of Oddi manometry (SOM) in patients with post-cholecystectomy pain and idiopathic recurrent acute pancreatitis (IRAP) is controversial. We sought to survey the American Gastroenterology community to define current approaches. Methods: An electronic survey was sent to U.S. members of the American Society of Gastrointestinal Endoscopy (ASGE) on May 1st , 2014 to assess their approach to SOD and IRAP. Results: There were 169 respondents, 54 (32%) of who worked in university hospitals and the majority (135, 80%) were endoscopic retrograde cholangiopancreatography (ERCP) providers. Utilization of magnetic retrograde cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) was significantly more often in IRAP than in SOD (69%, 72% vs 48%, 26% respectively). The majority (121, 90%) of ERCP providers perform ERCP in SOD or IRAP, although most (83, 69%) do not use SOM. Empiric biliary sphincterotomy (BS) was the dominant approach reported in patients with SOD type I (92%). Among the SOM providers, majority perform SOM directed BS in SOD type II (77%) and type III (75%). More than one-half perform SOM directed pancreatic sphincterotomy (PS) in SOD types II, III, and IRAP; less in SOD type I (33%). While less than one-third perform SOM directed dual sphincterotomy (DS) in SOD II, III, and IRAP; none in SOD type I. Conclusion: This survey of ASGE members shows low utilization of sphincter manometry and mixed utilization of ERCP for SOD types II-III and IRAP. More stringent research is required to guide clinical practice.