Botulinum toxin may predict the outcome of endoscopic sphincterotomy in episodic functional post-cholecystectomy biliary pain

Abstract

Botulinum toxin relaxation of the SO may be a useful method of predicting the symptom response to endoscopic sphincterotomy in patients who have episodic functional biliary pain.

Botulinum toxin-induced relaxation of the sphincter of Oddi may select patients with acalculous biliary pain who will benefit from cholecystectomy

“…The findings of this audit support the evidence that BTX relaxation of the SO may be a safe and reliable alternative to EBM for the diagnosis of ABP, with least four episodes per month caused by SOH [13]. Standard EBM can provide only a ''snapshot'' reading of a moment in time, and that reading may not represent the dominant pressure of the SO over time [16].…”

“…Sphincter of Oddi relaxation using BTX injections proved to be a straightforward and safe technique that can be undertaken by any endoscopist trained to perform ERCP [13]. The procedure was performed as a day case without complications using a 2-h postinjection serum amylase estimation to help screen for pancreatitis [15].…”

“…A positive BTX response was defined as a pain-free interval of at least 4 weeks after treatment followed by a return of previous symptoms as the effect of BTX wore off [13]. Patients who experienced this were offered biliary ES, performed within 4 weeks, and the patients who did not were counseled regarding LC.…”

“…There is evidence that relaxation of the SO by injection of botulinum toxin (BTX) may be a safe method for diagnosing biliary pain due to SOH [11][12][13]. The treatment for ABP with a low GBEF might be better rationalized and the outcome improved if patients underwent BTX injection into the SO before cholecystectomy is advised.…”

Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction?

“…Fibrotic criteria on EUS did not seem to predict manometric SOD at our institution. 23 Botulinum toxin injected near the sphincter has been shown in some preliminary studies to potentially predict response to therapy, 24,25 but defining response and differentiating brief placebo responses from real responses is difficult. In addition, it had a high rate of post-ERCP pancreatitis in 1 study.…”