Dysfunction at the Sphincter of Oddi can result in biliary-type abdominal pain. Geenen et al used several criteria to identify possibly Sphincter of Oddi dysfunction.



(1) biliary-type pain

(2) increased liver enzymes (AST and.or alkaline phosphatase > 2 times the upper limit of normal on at least 2 occasions)

(3) delayed drainage (> 45 minutes) of contrast material injected during ERCP in the absence of narcotics, anticholinergic agents, or other drugs known to affect the sphincter

(4) common bile duct dilated to > 12 mm



• If a cholecystectomy has been performed, the pain should last for more than 6 months after the procedure.

• Hepatobiliary scintigraphy with Technetium-DIDA can be used as an alternative if ERCP cannot be performed.


If all 4 criteria are present, then 80-90% of patients will have sphincter of Oddi dysfunction.


If only the first criteria is present, then sphincter of Oddi dysfunction is uncommon.


If a patient has the first criterion and at least one of the other criteria, then sphincter of Oddi dysfunction is possible and these patient should have manometry at the Sphincter of Oddi. The presence of elevated pressure at the sphincter (in the absence of drugs affecting the sphincter) indicates dysfunction is present.


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