The bulb of vater, also known as the great duodenal papilla, is located in the middle part of the 2nd segment (D2) of the duodenum. Balloon stenosis is characterized by inflammation and fibrosis of the duodenal papillary muscle. But this definition still does not clinically describe the presence of recurrent abdominal pain after cholecystectomy.

Gallbladder function plays an important role in the sphincter of Oddi mechanism and patients without a gallbladder are more likely to have sphincter of Oddi dysfunction. Other potential factors for sphincter of Oddi dysfunction include female sex, hypothyroidism, irritable bowel syndrome, pre-existing pancreatitis, and exogenous medications.

Sphincter of Oddi remains the gold standard for diagnosing sphincter of Oddi dysfunction. It is often combined with a diagnostic ERCP and includes manometric catheter adjustment. A triple-lumen catheter that allows continuous suction of the pancreatic duct may reduce the risk of post-procedural pancreatitis.

Acute pancreatitis is the major complication of sphincterotomy. Increased intraductal pressure, overfilling of the ductal system, dyscoagulability, and repeated pancreatic duct spasm and trauma have all been implicated as etiological factors, possibly due to impaired pancreatic duct drainage.