Summary
To verify the appropriateness of sphincterotomy as the treatment of choice of choledocholithiasis, since 1980 we have been using endoscopic retrograde cholangiopancreatographic (ERCP) manometry of the sphincter of Oddi (SO). This method allows direct investigation of SO motor activity and provides useful information regarding the presence of benign papillary stenosis (BPS). Thirty-four patients were investigated because the radiological examination indicated BPS might be present. Of these, 20 had common bile duct (CBD) stones, while the remaining 14 presented with biliarylike pain and one or more of the following: CBD dilation (larger than 12 mm); emptying of the ERCP contrast medium took longer than 45 min; abnormal liver function tests. Moreover, 8 healthy volunteers served as controls. Our results show that the incidence of SO motor anomalies is very low in the presence of choledocholithiasis, while it is substantial in patients with suspected SO dysfunction. These observations would suggest that, unlike the traditional view, BPS is rarely secondary to biliary lithiasis. Therefore, most of the sphincterotomies performed that are based on the assumption of underlying SO pathology should be considered unnecessary. Under these circumstances, the physiological role of a functioning SO has induced us to advocate sphincterotomy, surgical or endoscopic, in selected cases only.
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References
Carboni M, Negro P, Tuscano D, Flati G, Flati D, Guadagni S, Porowska B (1983) Stato attuale della sfinterotomia chirurgica ed endoscopica. Minerva Chir 38: 1771–1774
Csendes A, Kruse A, Funch-Jensen P, Oster MJ, Orushlt J, Amdrup E (1979) Pressure measurements in the biliary and pancreatic duct system in controls and in patients with gallstones, previous cholecystectomy, or common bile duct stones. Gastroenterology 77: 1203–1210
Funch-Jensen P, Kruse A, Ravensbaek J (1986) Reproducibility and estimation of minimal recording duration in endoscopic sphincter of Oddi manometry. Ital J Gastroenterol 18: 37–38
Geenen JE, Hogan WJ, Stewart E, Dodds WJ, Arndorfer RC (1979) ERCP manometry of the sphinoter of Oddi. In: Classen M, Geenen JE, Kaway K (eds) The papilla vateri and its diseases. Witzstrock, Baden-Baden Köln New York, pp 22–27
Gregg JA, Carr-Locke D (1984) Endoscopic pancretic and biliary manometry in pancreatic, biliary and papillary disease and after endoscopic sphincterotomy and surgical sphincteroplasty. Gut 25: 1247–1254
Guelrud M, Mendoza S, Vicent S, Gomez M, Villalta B (1985) Pressures in the sphincter of Oddi of patients with gallstones, common bile duct stones, and recurrent pancreatitis. J Clin Gastroenterol 5: 37–41
Habib FI (1986) Data from questionnaires. Ital J Gastroenterol 18: 35–37
Hess W (1979) Benign stenosis of the papilla of Vater. In: Classen M, Geenen JE, Kaway K (eds) The papilla vateri and its diseases. Witzstrock, Baden-Baden Köln New York, pp 22–27
Hogan WJ (1986) Sphincter of Oddi human physiology: the manometric era. Ital J Gastroenterol 18: 31–35
Hogan WJ (1987) Sphincter of Oddi dysfunction. In: Advances in hepato-biliary diseases seen in practice. Postgraduate Course of the AASLD, Chicago, 1987, pp 194–213
Hogan WJ, Geenen J, Dodds W, Toouli J, Venu R, Helm J (1983) Paradoxical motor response to cholecystokinin (CCK-OP) in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 82: 1085 (abstr)
Hogan WJ, Geenen JE, Venu RP, Dodds WJ, Helm J, Toouli J (1983) Abnormally rapid phasic contraction of the human sphincter of Oddi (tachyoddia). Gastroenterology 82: 1189–1193
Mallet-Guy R (1983) Benigne Papillenstenosen. Langenbecks Arch Chir 361: 147–149
Masi E de, Corazziari E, Habib FI, Fontana B, Gatti V, Fegiz GF, Torsoli A (1984) Manometric study of the sphincter of Oddi in patients with and without common bile duct stones. Gut 25: 275–278
Montori A, Risa L, Masoni L, Dell'Anna A (1985) Surgical or endoscopic options in the treatment of choledocholithiasis. In: Russo A, Magnano A (eds) Obstructive jaundice: endoscopic diagnosis and therapy. 2nd International Postgraduate Course in Diagnostic and Surgical Endoscopy, Catania, 1985, pp 90–102
Nardi G (1973) Papillitis and stenosis of the sphincter of Oddi. Surg Clin North Am 53: 1149–1160
Nebel OT (1975) Manometric evaluation of the papilla of Vater. Gastrointest Endosc 21: 126–128
Staritz M, Meyer zum Büschenfelde KH (1986) Investigation of the effect of diazepam and other drugs on the sphincter of Oddi motility. Ital J Gastroenterol 18: 41–43
Toouli J, Hogan WJ, Geenen JE, Stewart ET, Dodds WJ, Arndorfer RC (1980) Action of cholecystokinin octapeptide (CCK-OP) on sphincter of Oddi (SO) pressure and phasic wave activity in man. Gastroenterology 78: 1278–1285
Toouli J, Geenen JE, Hogan WJ, Dodds WJ, Arndorfer RC (1982) Sphincter of Oddi motor activity: a comparison between patients with common bile duct stones and controls. Gastroenterology 82: 111–117
Toouli J, Roberts-Thomson IC, Dent J, Lee J (1985) Manometric disorders in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 88: 1243–1250
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Masoni, L., Buccino, R.V., Miscusi, G. et al. Is ERCP manometry useful in the choice of treatment of stones of the common bile duct?. Surg Endosc 2, 59–65 (1988). https://doi.org/10.1007/BF00704351
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DOI: https://doi.org/10.1007/BF00704351