Improved predictors of outcome in postcholecystectomy pain.

BACKGROUND

Endoscopic interventions have limited efficacy in sphincter of Oddi dysfunction (SOD) Type 3. Improved predictors of response to treatment are needed.

METHODS

Patients with postcholecystectomy pain underwent a standardized history and physical examination and were then managed individually. Long-term outcome was determined by record review and telephone interview. Initial predictors of response to treatment were assessed.

RESULTS

Mean follow-up for the 74 subjects was 36 months. Fifty were improved, and 24 had persistent pain. Patients were likely to respond to sphincterotomy if their pain was not continuous, if it was accompanied by nausea or vomiting, and if there had been a pain free interval after cholecystectomy of at least 1 year. When 2 or 3 of these predictors were present, 85% of SOD Type 2 patients and 56% of Type 3 patients had a good response. Initial history and examination features also predicted response to treatment of neuropathic pain.

CONCLUSION

Among patients with postcholecystectomy pain, specific features of the initial history and examination predict response to treatment with higher accuracy than the SOD grade. These predictors identify a subset of Type 3 patients likely to respond to sphincterotomy.