Introduction There is still doubt about the role of manometry and endoscopic intervention in Type 2 sphincter of Oddi dysfunction (T2SOD). We aimed to examine the efficacy of a manometry guided approach in the evolving management of T2SOD in our tertiary clinical practice at Hammersmith Hospital, London, UK.

Methods We retrospectively evaluated all T2SOD patients referred between 2010 and 2014. Baseline characteristics and procedural outcomes were extracted including manometry readings, type of endoscopic intervention (sphincterotomy or Botulinum toxin injection), complications and pain improvement at 3 and 12 months.

Results 74 T2SOD patients were identified, 17 of whom were excluded due to prior sphincterotomy or follow up elsewhere. Botulinum toxin injection was performed in 11 patients with normal manometry; 27% of whom reported short term but unsustained benefit. 46 patients were managed with dual sphincterotomy. Sustained benefit at 12 months was seen significant more often in those with abnormal (72%) than normal (21%) sphincter pressure (p = 0.046, OR = 4.6, CI: 1.2–17.5). Complications occurred in 19.2% (11/57) of patient’s post-sphincterotomy, but interestingly were confined only to those with abnormal manometry. Initial pain relief after cholecystectomy (p = 0.037, OR = 11.7, CI = 1.227–110.953) predicted better outcome while those with prior hysterectomy (p = 0.039, OR = 0.039, CI = 0.006-0.849) had worse outcome. Daily opiate users were more likely to suffer complications (p = 0.072, OR = 6.333, CI = 1.114–35.997). Finally, biliary and pancreatic sphincter pressures correlated highly (R = 0.586, p < 0.001).

Conclusion We found abnormal manometry predicted both sustained pain improvement post-sphincterotomy and complications. The increased complication risk seems attributable to the underlying disease highlighting the safety of manometry itself. The correlation between biliary and pancreatic sphincter pressure suggests measurement of both may not be necessary before dual sphincterotomy after confirmation of sphincter hypertension. Our study of all-comers advocates a strategy of manometry-defined endoscopic intervention in T2SOD.

Disclosure of Interest None Declared