Sphinkter-Oddi-Dyskinesie

H.-D. Allescher1
1Zentrum Innere Medizin, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland

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Die Sphinkter-Oddi-Dyskinesie (SOD) ist eine Funktionsstörung der Papillenregion, die zu klinischen Symptomen und zu einer funktionellen Behinderung des Abflusses von Galle- und Pankreassekret führen kann. Basierend auf der Ausprägung der klinischen Veränderungen und der Erkrankungsschwere wird die SOD in 3 Typen eingeteilt, die biliären oder pankreatischen Typen I–III. Die Existenz und Diagnose der SOD ist nicht ganz unumstritten. Die manometrische Diagnose mithilfe der Sphinkter-Oddi-Manometrie wird durch das relativ hohe Risiko einer Pankreatitis nach endoskopischer retrograder Cholangiopankreatikographie eingeschränkt. Während die Papillenmanometrie in Nordamerika häufiger durchgeführt wird, erfolgt sie in Europa nur in Ausnahmefällen. Manometrisch ist die SOD durch einen erhöhten Druck im Sphinktersegment der Gallenwege und/oder des Pankreas gekennzeichnet. Diese Druckerhöhung kann mit einer endoskopischen Papillotomie gesenkt werden. Kontrovers diskutiert wird, ob primär eine invasive Diagnostik durchgeführt werden sollte oder ob in einem pragmatischen klinischen Ansatz direkt eine Papillotomie durchzuführen ist, wenn der klinische Verdacht auf eine SOD besteht. Für Patienten mit biliärem oder pankreatischem Typ I ist die endoskopische Papillotomie die Therapie der Wahl. Bei Patienten mit einem biliären Typ II kann die Sphinkter-Oddi-Manometrie die Therapieentscheidung erleichtern. Bei Patienten mit Typ III besitzt die Funktionsdiagnostik mit Manometrie nur eine geringe Aussagekraft und hat daher nur einen geringen prädiktiven Wert für den Behandlungserfolg.

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