Sphincter of Oddi Dysfunction After Cholecystectomy
Sphincter of Oddi dysfunction occurs in approximately 5% of post-cholecystectomy patients, though the reported prevalence varies from 1-14% depending on patient selection and diagnostic criteria used. 1
Prevalence Data
The incidence of sphincter of Oddi dysfunction (SOD) in post-cholecystectomy patients varies significantly based on the population studied and diagnostic methods employed:
In liver transplant recipients: SOD occurs in up to 5% of patients due to denervation of the sphincter during surgery 1, 2
In general post-cholecystectomy populations: The prevalence ranges from 1-1.5% in unselected post-cholecystectomy patients, but increases to approximately 14% in selected groups of patients specifically complaining of post-cholecystectomy symptoms 3
Among post-cholecystectomy patients referred for ERCP: One study found that 9% of 451 consecutive patients with post-cholecystectomy symptoms had SOD 4
Diagnostic Considerations by Clinical Subgroup
The frequency of manometrically-confirmed SOD differs substantially based on clinical presentation 3:
Biliary Type I patients (pain + abnormal liver enzymes + dilated bile duct): 65-95% have SOD, predominantly due to sphincter stenosis 3
Biliary Type II patients (pain + either abnormal enzymes OR dilated duct): 50-63% have confirmed SOD 3
Biliary Type III patients (pain only, normal enzymes and duct): 12-28% have SOD 3
Clinical Context and Pitfalls
Important caveat: The wide range in reported prevalence (1-14%) reflects differences in patient selection, with higher rates seen in symptomatic patients referred for specialized evaluation versus unselected post-cholecystectomy populations 3. This distinction is critical when counseling patients about their risk.
Key diagnostic point: Quantitative hepatobiliary scintigraphy can identify SOD non-invasively, with studies showing that 76.8% of post-cholecystectomy patients with suspected SOD demonstrate shortened bile transit times consistent with sphincter dysfunction 5. This test may help identify which patients warrant further invasive evaluation with manometry.
The correlation between SOD and duodenal motor-evacuator dysfunction (r = 0.57) and duodenogastric reflux (r = 0.74) suggests that SOD is often part of a broader motility disorder rather than an isolated phenomenon 5.