**4. Sphincter of Oddi dysfunction**

Sphincter of Oddi Dysfunction (SOD) is the most frequent cause of idiopathic recurrent acute pancreatitis with a prevalence rate between 15–72% among patients with idiopathic recurrent pancreatitis using ERCP with raised SOD basal pressures at sphincter of Oddi manometry (SOM) as the gold standard for diagnosis and 50–87% among those with chronic pancreatitis [18, 20]. The pathogenesis of pancreatitis in SOD involves increase in the intrapancreatic ductal pressures. The elevation in the intraductal pressure results from either anatomic obstruction of the Sphincter of Oddi by fibrosis and/or inflammation or from functional obstruction caused by sphincter muscle spasms.

Endoscopic therapies such as pancreatic and biliary sphincterotomy can be employed in treating pancreas divisum and/or sphincter of Oddi dysfunction especially in patients with recurrent acute pancreatitis. These therapies are however associated with a significant risk of precipitating acute pancreatitis and hemorrhage, and so should be performed in specialized units and with careful patient selection [3, 21].

Endoscopic injection of botulinum toxin decreases pancreatitis episodes in 80% of patients with acute idiopathic pancreatitis. However, the effect is short-lived with also concerns regarding side effects. Dual sphincterotomy has been demonstrated to have lower rates of pancreatitis recurrence compared to either biliary or pancreatitic sphincterotomy alone.

Temporary pancreatic stent placement is recommended to prevent post-procedure pancreatitis [19, 21].
