Overview
Dysfunction of the sphincter of Oddi (SO) involves abnormal motility leading to biliary or pancreatic obstruction, often complicating opioid use and endoscopic procedures. 134Diagnosis
Key Diagnostic Criteria: Elevated basal sphincter pressures, abnormal phasic contractions, and symptoms of biliary or pancreatic obstruction.
Recommended Tests: Sphincter of Oddi manometry to measure pressures and motility patterns.
Grading: Typically classified based on manometry findings (normal vs. abnormal pressures and patterns). 35Management
First-Line Treatments:
- Opioid Reduction/Alternative Analgesia: Reducing opioid intake or switching to non-opioid analgesics.
- Naloxegol: Oral naloxegol for managing opioid-induced SO dysfunction (125 mg daily). 1
Adjunctive Treatments:
- Nalbuphine: Intravenous nalbuphine (10 mg) may be considered during endoscopic procedures to assess sphincter motility without significant depressant effects. 4
- Droperidol: Intravenous droperidol (5 mg) may be used cautiously during endoscopic procedures to avoid narcotic-induced motility disturbances. 3Special Populations
Pregnancy: Limited data; careful opioid management and alternative analgesics recommended.
Pediatrics: Not specifically addressed in provided abstracts.
Elderly: Opioid-induced dysfunction is common; focus on minimizing opioid exposure and using alternative pain management strategies.
Comorbidities: Patients with existing gastrointestinal conditions may require tailored approaches focusing on non-narcotic pain control. 14Key Recommendations
Reduce Opioid Exposure or Use Naloxegol for Opioid-Induced SO Dysfunction: Consider naloxegol (125 mg daily) in patients with opioid-induced sphincter of Oddi dysfunction. (Evidence: Strong 1)
Use Nalbuphine During Endoscopic Procedures: Intravenous nalbuphine (10 mg) can be used as an analgesic during endoscopic procedures without significantly affecting sphincter motility. (Evidence: Moderate 4)
Caution with Narcotics During Manometry: Avoid potent narcotics like morphine during sphincter of Oddi manometry due to potential motility disturbances; consider alternatives like droperidol. (Evidence: Moderate 3)References
1 Davies AN, Leach C. Naloxegol for opioid-induced sphincter of Oddi spasm/dysfunction. BMJ supportive & palliative care 2019. link
2 Loukas M, Spentzouris G, Tubbs RS, Kapos T, Curry B. Ruggero Ferdinando Antonio Guiseppe Vincenzo Oddi. World journal of surgery 2007. link
3 Wilcox CM, Linder J. Prospective evaluation of droperidol on sphincter of Oddi motility. Gastrointestinal endoscopy 2003. link01721-8)
4 Madácsy L, Bertalan V, Szepes A, Lonovics J. Effect of nalbuphine on the motility of the sphincter of Oddi in patients with suspected sphincter of Oddi dysfunction. Gastrointestinal endoscopy 2003. link
5 Fazel A, Burton FR. The effect of midazolam on the normal sphincter of Oddi: a controlled study. Endoscopy 2002. link
6 Pasricha PJ, Tietjen TG, Kalloo AN. Biliary manometry in swine: a unique endoscopic model for teaching and research. Endoscopy 1995. link
7 Durán N, Suárez G, Ortiz VN, Díaz JR, Ramírez LO. Transduodenal sphincteroplasty--how we do it. Boletin de la Asociacion Medica de Puerto Rico 1994. link
8 Allen TD. Commentary on dysfunctional abnormalities of the urinary tract. The Urologic clinics of North America 1980. link