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Surgical Endoscopy

, Volume 3, Issue 4, pp 216–219 | Cite as

Sphincter of Oddi response to caerulein after endoscopic sphincterotomy for papillary stenosis

  • Akihiro Yasui
  • Yuji Nimura
  • Junichi Kamiya
  • Tetsuo Hayakawa
  • Tokimune Shibata
  • Shigehiko Shionoya
Case Reports

Summary

Using a percutaneous transhepatic cholangioscopy (PTCS) catheter, sphincter of Oddi motility was measured in a patient with papillary stenosis secondary to bile duct stones. Prior to sphincterotomy, intramuscular injection of 20 μg caerulein did not inhibit pathological contraction waves of the sphincter of Oddi or relieve abdominal pain. Endoscopic sphincterotomy of the lower segment of the sphincter of Oddi resulted in recovery of the normal response to caerulein, i.e. relaxation of the sphincter of Oddi. This observation indicates that the pathological contraction and lack of relaxation to cholecystokinin in a patient with papillary stenosis is due to high common bile duct pressure. The measurement of motility of sphincter of Oddi via the PTCS route is useful in diagnosing motor disorders in the sphincter of Oddi and is helpful in deciding to perform endoscopic sphincterotomy.

Key words

Sphincter of Oddi Sphincter of Oddi dysfunction Endoscopic sphincterotomy 

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References

  1. 1.
    Bar-Meir S, Geenen JE, Hogan WJ, Dodds WJ, Stewart ET, Arndorfer RC (1979) Biliary and pancreatic duct pressures measured by ERCP manometry in patients with suspected papillary stenosis. Dig Dis Sci 24: 209–213Google Scholar
  2. 2.
    Coelho JCU, Gouma DJ, Moody FG, Schegel JF (1986) Effect of feeding on myoelectric activity of the sphincter of Oddi and the gastrointestinal tract in the opossum. Dig Dis Sci 31: 202–207Google Scholar
  3. 3.
    Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Venu RP (1989) The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med 320: 82–87Google Scholar
  4. 4.
    Guelrud M (1988) Papillary stenosis. Endoscopy 20: 193–202Google Scholar
  5. 5.
    Hastbacka J, Jarvinen H, Kicilaakso E, Turunen MT (1986) Results of sphincteroplasty in patients with spastic sphincter of Oddi. Scand J Gastroenterol 21: 516–520Google Scholar
  6. 6.
    Hogan WJ, Geenen JE, Dodds WJ, Toouli J, Venu R, Helm J (1985) Paradoxical motor response to cholecystokinin (CCK-OP) in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 82: 1085Google Scholar
  7. 7.
    Hogan WJ, Geenen JE, Doods WJ (1987) Dysmotility disturbances of the biliary tract: classification, diagnosis and treatment. Semin Liver Dis 7: 302–310Google Scholar
  8. 8.
    Sonnenberg E van, Ferrucci JT, Neff CC, Mueller PR, Simeone JF, Wittenberg J (1983) Biliary pressure: manometric and perfusion studies at percutaneous transhepatic cholangiography and percutaneous biliary drainage. Radiology 148: 41–50Google Scholar
  9. 9.
    Staritz M, Ewe K, Meyer zum Büschenfelde K-H (1985) Effect of the artificially elevated common bile duct pressure on the motor activity and function of the papilla of Vater. A study by endoscopic manometry. Digestion 31: 61–66Google Scholar
  10. 10.
    Steinberg WM (1988) Sphincter of Oddi dysfunction: a clinical controversy. Gastroenterology 95: 1409–1415Google Scholar
  11. 11.
    Thatcher BS, Sivak MV, Tedesco FJ, Vennes JA, Hutton SW, Achkar EA (1987) Endoscopic sphincterotomy for suspected dysfunction of the sphincter of Oddi. Gastrointest Endosc 33: 91–95Google Scholar
  12. 12.
    Toouli J, Roberts-Thompson IC, Dent J, Lee J (1985) Manometric disorders in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 88: 1243–1250Google Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • Akihiro Yasui
    • 1
  • Yuji Nimura
    • 1
  • Junichi Kamiya
    • 1
  • Tetsuo Hayakawa
    • 2
  • Tokimune Shibata
    • 2
  • Shigehiko Shionoya
    • 1
  1. 1.1st Department of SurgeryNagoya University School of MedicineNagoyaJapan
  2. 2.2nd Department of Internal MedicineNagoya University School of MedicineNagoyaJapan

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