Skip to main content
SpringerLink
Log in

Normal sphincter of Oddi motor function

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

With the introduction of endoscopic retrograde cholangiopancreatography (ERCP) manometry, the characteristics of sphincter of Oddi (SO) motor activity have been described. SO manometry is the only available method to measure SO motor activity directly and is usually performed at the time of ERCP. SO manometry is considered to be the gold standard for evaluating patients for sphincter dysfunction. This review reports the technique of SO manometry and normal values for SO manometry. SO motility is characterized by prominent phasic contractions superimposed on a tonic pressure. Elevated basal SO pressure is the most consistent and reliable criteria to diagnose SO dysfunction. Basal pressures obtained from the biliary sphincter are similar to the basal pressure obtained from the pancreatic sphincter. Abnormal SO manometric values are shown. Factors that influence SO pressures, and interpretation of SO manometric tracing are discussed. The most common and serious complication of SO manometry is post-manometry pancreatitis. In healthy volunteers with normal sphincter function, pancreatitis is almost never seen. However, in patients with SO dysfunction, the incidence of pancreatitis is high. The use of new nonperfused microtransducers may reduce this complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Torsoli A, Corazziari E, Habib FI, et al.: Frequencies and cyclical pattern of the human sphincter of Oddi phasic activity. Gut 1986, 27:363–369.

    PubMed  CAS  Google Scholar 

  2. Nebel OT: Manometric evaluation of the papillar of Vater. Gastrointest Endosc 1975, 21:126–128.

    PubMed  CAS  Google Scholar 

  3. Arndorfer RC, Stef JJ, Dodds WJ, et al.: Improved infusion system for intraluminal esophageal manometry. Gastroenterology 1977, 73:23–27.

    PubMed  CAS  Google Scholar 

  4. Lehman GA: Endoscopic sphincter of Oddi manometry: a clinical practice and research tool. Gastrointest Endosc 1991, 37:490–492.

    PubMed  CAS  Google Scholar 

  5. Sherman S, Troiano FP, Hawes RH, et al.: Sphincter of Oddi manometry: decreased risk of clinical pancreatitis with use of a modified aspirating catheter. Gastrointest Endosc 1990, 36:462–466. This study shows that the use of an aspirating catheter for SOM reduces the incidence of post-manometry pancreatitis.

    PubMed  CAS  Google Scholar 

  6. Blaut U, Sherman S, Fogel EL, et al.: The influence of variable stiffness guidewires on basal biliary sphincter of Oddi pressure measured at ERCP. Gastrointest Endosc 2002, 55:83A.

    Article  Google Scholar 

  7. Wehrmann T, Schmitt T, Schonfeld A, et al.: Endoscopic sphincter of Oddi manometry with a portable electronic microtransducer system: comparison with the perfusion manometry method and routine clinical application. Endoscopy 2000, 32:444–451.

    Article  PubMed  CAS  Google Scholar 

  8. Craig AG, Omari T, Lingenfelser T, et al.: Development of a sleeve sensor for measurement of sphincter of Oddi motility. Endoscopy 2001, 33:651–657.

    Article  PubMed  CAS  Google Scholar 

  9. Wehrmann T, Stergiou N, Schmitt T, et al.: Reduced risk for pancreatitis after endoscopic microtransducer manometry of the sphincter of Oddi: a randomized comparison with the perfusion manometry technique. Endoscopy 2003, 35:472–477. This study shows that the use of nonperfused microtransducer catheter for SOM reduces the incidence of post-manometry pancreatitis.

    Article  PubMed  CAS  Google Scholar 

  10. Guelrud M, Mendoza S, Rossiter G, et al.: Sphincter of Oddi manometry in healthy volunteers. Dig Dis Sci 1990, 35:38–46. The largest study establishing normal values for SOM in 50 asymptomatic control subjects.

    Article  PubMed  CAS  Google Scholar 

  11. Rolny P, Arleback A, Funch-Jensen P, et al.: Clinical significance of manometric assessment of both pancreatic duct and bile duct sphincter in the same patient. Scand J Gastroenterol 1989, 24:751–754.

    PubMed  CAS  Google Scholar 

  12. Aymerich RR, Prakash C, Aliperti G: Sphincter of oddi manometry: is it necessary to measure both biliary and pancreatic sphincter pressures? Gastrointest Endosc 2000, 52:183–186.

    Article  PubMed  CAS  Google Scholar 

  13. Habib FI, Corazziari E, Biliotti D, et al.: Manometric measurement of human sphincter of Oddi length. Gut 1988, 29:121–125.

    PubMed  CAS  Google Scholar 

  14. Kalloo AN, Tietjen TG, Pasricha PJ: Does intrabiliary pressure predict basal sphincter of Oddi pressure? A study in patients with and without gallbladders. Gastrointest Endosc 1996, 44:696–699.

    Article  PubMed  CAS  Google Scholar 

  15. Sherman S, Gottlieb K, Uzer MF, et al.: Effects of meperidine on the pancreatic and biliary sphincter. Gastrointest Endosc 1996, 44:239–242.

    Article  PubMed  CAS  Google Scholar 

  16. Fazel A, Li SC, Burton FR: Octreotide relaxes the hypertensive sphincter of Oddi: pathophysiological and therapeutic implications. Am J Gastroenterol 2002, 97:612–616.

    Article  PubMed  CAS  Google Scholar 

  17. Elta GH, Barnett JL: Meperidine need not be proscribed during sphincter of Oddi manometry. Gastrointest Endosc 1994, 40:7–9.

    Article  PubMed  CAS  Google Scholar 

  18. Wilcox CM, Linder J: Prospective evaluation of droperidol on sphincter of Oddi motility. Gastrointest Endosc 2003, 58:483–487.

    Article  PubMed  Google Scholar 

  19. Fogel EL, Sherman S, Bucksot L, et al.: Effects of droperidol on the pancreatic and biliary sphincters. Gastrointest Endosc 2003, 58:488–492.

    Article  PubMed  Google Scholar 

  20. Goff JS: Effect of propofol on human sphincter of Oddi. Dig Dis Sci 1995, 40:2364–2367.

    Article  PubMed  CAS  Google Scholar 

  21. Staritz M, Poralla T, Ewe K, et al.: Effect of glyceryl trinitrate on the sphincter of Oddi motility and baseline pressure. Gut 1985, 26:194–197.

    PubMed  CAS  Google Scholar 

  22. Guelrud M, Mendoza S, Rossiter G, et al.: Effect of nifedipine on sphincter of Oddi motor activity: studies in healthy volunteers and patients with biliary dyskinesia. Gastroenterology 1988, 95:1050–1055.

    PubMed  CAS  Google Scholar 

  23. Binmoeller KF, Harris AG, Dumas R, et al.: Does the somatostatin analogue octreotide protect against ERCP induced pancreatitis? Gut 1992, 33:1129–1133.

    PubMed  CAS  Google Scholar 

  24. Geenen JE, Hogan WJ, Dodds WJ, et al.: The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med 1989, 320:82–87.

    Article  PubMed  CAS  Google Scholar 

  25. Pasricha PJ, Miskovsky EP, Kalloo AN: Intrasphincteric injection of botulinum toxin for suspected sphincter of Oddi dysfunction. Gut 1994, 35:1319–1321.

    PubMed  CAS  Google Scholar 

  26. Thune A, Scicchitano J, Roberts-Thomson I, et al.: Reproducibility of endoscopic sphincter of Oddi manometry. Dig Dis Sci 1991, 36:1401–1405.

    Article  PubMed  CAS  Google Scholar 

  27. Smithline A, Hawes R, Lehman G: Sphincter of Oddi manometry: interobserver variability. Gastrointest Endosc 1993, 39:486–491.

    Article  PubMed  CAS  Google Scholar 

  28. Funch-Jensen P, Kruse A, Ravnsbaek J: Endoscopic sphincter of Oddi manometry in healthy volunteers. Scand J Gastroenterol 1987, 22:243–249.

    PubMed  CAS  Google Scholar 

  29. Varadarajulu S, Hawes RH, Cotton PB: Determination of sphincter of Oddi dysfunction in patients with prior normal manometry. Gastrointest Endosc 2003, 58:341–344.

    Article  PubMed  Google Scholar 

  30. Lee SK, Kim MH, Seo DW, et al.: Frequency of phasic wave contraction is variable during long-term sphincter of Oddi manometry. Am J Gastroenterol 1996, 91:2395–2398.

    PubMed  CAS  Google Scholar 

  31. Freeman ML, DiSario JA, Nelson DB, et al.: Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001, 54:425–434. A large comprehensive multivariate analysis of risk factors for post-ERCP pancreatitis.

    Article  PubMed  CAS  Google Scholar 

  32. Maldonado ME, Brady PG, Mamel JJ, et al.: Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry (SOM). Am J Gastroenterol 1999, 94:387–390.

    Article  PubMed  CAS  Google Scholar 

  33. Rolny P, Anderberg B, Ihse I, et al.: Pancreatitis after sphincter of Oddi manometry. Gut 1990, 31:821–824.

    PubMed  CAS  Google Scholar 

  34. Tarnasky PR, Palesch YY, Cunningham JT, et al.: Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology 1998, 115:1518–1524. This study shows the protective efficacy of pancreatic stents in patients with SO dysfunction undergoing biliary sphincterotomy.

    Article  PubMed  CAS  Google Scholar 

  35. Fogel EL, Eversman D, Jamidar P, et al.: Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone. Endoscopy 2002, 34:280–285.

    Article  PubMed  CAS  Google Scholar 

  36. Fazel A, Quadri A, Catalano MF, et al.: Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study. Gastrointest Endosc 2003, 57:291–294.

    Article  PubMed  Google Scholar 

  37. Devereaux BM, Fogel EL, Aisen A: Secretin-stimulated functional MRCP: correlation with sphincter of Oddi manometry [abstract]. Gastrointest Endosc 2000, 51:A197.

    Article  Google Scholar 

  38. Mariani A, Curioni S, Zanello A, et al.: Secretin MRCP and endoscopic pancreatic manometry in the evaluation of sphincter of Oddi function: a comparative pilot study in patients with idiopathic recurrent pancreatitis. Gastrointest Endosc 2003, 58:847–852.

    Article  PubMed  Google Scholar 

  39. Madacsy L, Middelfart HV, Matzen P, et al.: Video manometry of the sphincter of Oddi: a new aid for interpreting manometric tracings and excluding manometric artifacts. Endoscopy 2000, 32:20–26.

    Article  PubMed  CAS  Google Scholar 

  40. Wehrmann T, Stergiou N, Riphaus A, et al.: Correlation between sphincter of Oddi manometry and intraductal ultrasound morphology in patients with suspected sphincter of Oddi dysfunction. Endoscopy 2001, 33:773–777.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Tufts University School of Medicine, Tufts New England Medical Center, 750 Washington Street, Box 233, 02111, Boston, MA, USA

    Kinnari Kher MD & Moises Guelrud MD

Authors
  1. Kinnari Kher MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moises Guelrud MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kher, K., Guelrud, M. Normal sphincter of Oddi motor function. Curr Gastroenterol Rep 6, 163–168 (2004). https://doi.org/10.1007/s11894-004-0044-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-004-0044-z

Keywords

Search

Navigation