Botulinum toxin injection as a diagnostic tool for verification of sphincter of Oddi dysfunction causing recurrent pancreatitis

Abstract

Sphincter of Oddi dyskinesia (SOD) is among the less frequent causes of acute recurrent pancreatitis. We report on a patient with frequent pain attacks accompanied by pancreatic enzyme elevation, in whom a transitory decrease of the SO pressure following endoscopic botulinus toxin injection was a diagnostic clue for SOD. The patient's symptoms resolved for 4 months, after which time recurrent symptoms paralleled the reoccurrence of the elevated SO pressure. Endoscopic sphincterotomy of the biliary sphincter relieved her symptoms for the subsequent follow-up period which is now 10 months.