Sphincter of Oddi Dismotility

[MegRN]

I have had RUQ pain for 6 years now. After multiple CT's, US and plain films, my GI sent me to MUSC (I live in Va) to see Dr Peter Cotton (a great guy by the way) He did an ERCP but my pressures weren't up at that specific time so he did an investigational drug placement--which was botox.This kept the sphinctor from spasming. He said it would last 6 months and after that he could do a sphincterotomy since it would be proven that it was the sphincter of oddi causing the problem. Sure enough, 6 months later the pain came back so I went back to MUSC and he did the sphincterotomy. Problem solved. Or so I thought. Four years after the procedure, the pain started coming back. More CT etc (all were normal as they were the first time around) I had another sphinterotomy. I didn't realize that the sphincter could restenose. It's been 18-24 months since the 2nd  procedure. Unfortunately, the pain is back again.

After all this being said here are the questions.How likely is it that the sphinter has restenosed yet again? If it has, is it normal for the time periods between problems to be shorter with each sphinterotomy? How many times can I have this done?

Any help/opinions would be greatly appreciated.

[kkrumrine]

my SOD was diagnosed by a radiologist doing an upper GI with small bowel follow through. This because I  began having RUQ colic and nausea with increasing frequency and intensity two years post lap chole. The doc (PA) in my case had run every test known to rule out what could be making me so sick. I had developed pancreatitis as well. Once the dx was made I was referred to a GI  doc specialized in ERCP;  performing > 100/ERCP/YR. My first ERCP was for stent placement. No manometry was required as the results of the UGIWSBFT were clear that SOD was present. The question of how high the pressure was in my duct was answered when the stent blew out within the first twenty four hours and was hanging in my duodenum. Since then I have undergone five ERCP's with sphincterotomy each time. My last one was 1 1/2 yrs ago. That one nearly killed me. The duct was extremely stenosed requiring the doc to cut "a generous sphincterotomy"; unfortunately I also ended up with a duodenal perforation requiring a two week stay in ICU. I had to have a central line placed into my heart, a Naso gastric tube into my stomach, and it took the surgeon ten days to decide whether or not to operate. I had projectile hematemesis, bloody stool, liver, cardiac trauma, subcutaneous emphysema,  pneumopericardium, and more. I am very symptomatic again and have Kaiser now, so now have to find a new specialist! UGH! It doesnt help, my being an RN, as sometimes knowledge is a two edged sword.

[CalGal]

Unfortunately, there is no 'standard' as to a time frame on when, or if, the sphincter will cause problems after a sphincterotomy. Some people can go forever, others have continuing problems.

Studies have suggested that people who do not have elevated pressures have more problems with a sphincterotomy than those who do. When the cut was made, were your pressures measured? As miserable as it sounds, have you considered botox again, or stenting?