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Suspected sphincter of Oddi disorder — ESEGH MCQ

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HardPancreatico-biliary DiseaseSuspected sphincter of Oddi disorderESEGH

A 43-year-old woman has episodic biliary-type pain 18 months after cholecystectomy. Liver tests transiently rise during attacks and MRCP shows no stone or stricture. EUS is normal. Manometry is being considered. What is the most appropriate management?

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Correct answer: E — Specialist review before any sphincter intervention

The best answer is “Specialist review before any sphincter intervention”. Specialist pancreatobiliary review before considering sphincter intervention The alternatives “No further review despite objective liver test changes”, “Empirical ERCP sphincterotomy in primary care referral pathway”, “Long-term opioid escalation, within a guideline-based pathway”, “Total gastrectomy, after multidisciplinary assessment” are plausible in related gastroenterology presentations but do not match the defining finding, threshold, sequence or UK pathway in this stem.

Reference: NICE NG85 pancreatic cancer recommendations: https://www.nice.org.uk/guidance/ng85/chapter/Recommendations