Postcholecystectomy syndrome. How to determine if the sphincter of Oddi is the cause.

Recurrence of pain after cholecystectomy is common. This postcholecystectomy syndrome, defined as pain that is unexplained by upper abdominal radiologic and/or endoscopic studies, including endoscopic retrograde cholangiopancreatography, often results from sphincter of Oddi dysfunction. Endoscopic demonstration of elevated sphincter of Oddi pressures is required for diagnosis. The treatment of choice is usually endoscopic sphincterotomy, which yields long-term relief in most patients. Surgical sphincteroplasty or use of calcium channel blockers or long-acting nitrates may be effective if endoscopic sphincterotomy is not suitable.