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Conferences and Medical Updates

Biliary Dyskinesia

Biliary dyskinesia

  • Biliary and pancreatic SOD
  • SOD evaluation – invasive and non invasive
  • Hopkins scintographic score for biliary SOD dynfunction.  100% sensitivity and specificity.  Drawback is does not evaluate pancreatic SOD.
  • Secretin stimulated MRCP – 0.5 cm increase in PD size suggests pancreatic SOD.
  • ERCP 30% of patients will develop pancreatitis in SOD.  DO NOT DO ERCP.
  • Chronic abd. pain – 60% of them had SOD.  10% isolated biliary SOD, 20% had ioslated pancreatic SOD and 30% had both.
  • Rx is antispasomodics – smooth muscle relaxants, botox injections, CCBs
  • Gold standards is biliary sphincterotomy.
  • Type 2 and type 3 biliary – do sphincterotomy.
  • Causes of pain after sphincterotomy – residual SODor pancreatic SOD or chronic pancreatitis or non pancreaticobiliary cause.
  • Should patients get pancreatic sphincterotomy with biliary sphincterotomy ?  On going study.