Sphincter of Oddi dysfunction (SOD) and functional biliary pain are overlapping difficult to treat biliary disorders that are defined by the Rome IV criteria and is seen particularly in post cholecystectomy patients. Typically, patients feel a colicky right upper quadrant abdominal pain.  

SOD involves a structural or functional obstruction of the sphincter, impairing bile flow. It is classified as type 1 when both imaging abnormalities and elevated liver tests are present, and type 2 when only one is evident. When typical biliary pain occurs without objective evidence of obstruction or inflammation, it is termed functional biliary pain, reflecting visceral hypersensitivity to pain. 

The role of endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy in these patients remains controversial, particularly following recent evidence questioning their efficacy and highlighting potential risks.  

Data of outcomes in this patient cohort is limited. We aimed to retrospectively assess our patient cohort.  

All new referrals were reviewed at a weekly multidisciplinary team (MDT) meeting. We examined MDT records from 2019 and identified the first 50 consecutive patients referred with a diagnosis of Sphincter of Oddi Dysfunction (SOD). Collected data included demographics, symptom profile, previous biliary surgery, imaging findings, liver function tests (LFTs), ERCP and sphincterotomy details, procedure-related complications, clinical outcomes, and duration of follow-up. For analysis, Type 2 SOD was further subclassified into cases with isolated liver function test abnormalities (Type 2–LFTs) and those with isolated imaging abnormalities (Type 2–Imaging) 

The fifty patients were identified, with a mean age of 41.2 years; 96% were female and 94% were White. The mean follow-up duration was 4.7 years. Prior cholecystectomy had been performed in 84% of patients, with 58% reporting similar pain before surgery. 

Diagnoses included Type 1 SOD (n=6), Type 2 SOD–Imaging (n=4), Type 2 SOD–LFTs (n=23), functional biliary pain (n=14), and non-biliary pain (n=3). Among SOD patients, mean peak ALT and ALP were 231 U/L and 153 U/L, respectively. Twenty-four SOD patients and two with functional biliary pain underwent ERCP, all of whom had sphincterotomy performed. 

Post-procedure complications included pancreatitis in 7 patients (26.9%), post-sphincterotomy bleeding in 2 (7.7%), and perforation in 1 (3.8%). The mean length of stay for patients with pancreatitis was 11 days. Of the 26 patients who underwent ERCP, 11 (42%) reported no symptomatic improvement at their first follow up post-procedure, and 14 (54%) reported no improvement at latest follow-up. 

In this cohort, the majority of patients referred with suspected SOD were young females, most of whom had previously undergone cholecystectomy. ERCP with sphincterotomy was associated with a higher-than-expected complication rate and limited long-term symptomatic benefit. These findings underscore the importance of careful patient selection and informed counselling. Comprehensive analysis of the full cohort of over 150 patients is ongoing and will be reported separately.