Sphincter of Oddi and Pancreatic Sphincter Dysmotility
How a sphincter that controls the flow of bile and pancreatic juice may cause pain and suffering is based on an understanding of fluid hydraulics. The basic concept that allows one not only to investigate, but to understand the mechanisms and the etiologies that revolve around sphincter of Oddi dysfunction (SOD) is the concept that fluids are non-compressible. While fluid can exert pressure, it is not compressible. Therefore, when one exposes fluid that is contained in the bile duct or the pancreatic duct to an obstructive force, the consequence is that the fluid will exert its pressure on the tissues within and around those ductal systems. The advent of manometric systems using micro-bore tubing in concert with very low compliance, high fidelity transducers, has allowed one the opportunity to investigate the level and character of the obstruction in these systems. Most investigators believe that when a sphincter of Oddi malfunctions, the type of malfunction can be divided into either a fixed high-pressure zone, which we will call an area of fibrosis, or an area of Papillary Stenosis. The alternative dysfunction of the sphincter Oddi is that of a motor dysfunction or a Dyskinesia. Therefore, in this text, we will be discussing diseases which evolve around fixed areas of fibrosis in sphincter of Oddi vs. a sphincter of Oddi that has an abnormal pattern of muscle function. Some patients may have a component of both diseases. This chapter will cover in some detail how and when to evaluate these patients. The main tool discussed in this chapter will be how and when to use manometry in the diagnosis and direction of treatment in patients with SOD.
KeywordsBile Duct Pancreatic Duct Endoscopic Sphincterotomy Sphincter Dysfunction Biliary Dyskinesia
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- 1.Oddi R. D’une disposition a sphincter speciale de l’ouverture du canal choledoque. Arch Ital de Biol 1887;8:317.Google Scholar
- 4.Soffer EE, Johlin FC. Intestinal dysmotility in patients with sphincter of Oddi dysfunction. A reason for failed response to sphincterotomy. Dig Dis Sei 1993;39:593–595.Google Scholar
- 11.Bader M, Geenen JE, Hogan WJ, Dodds WJ, et al. Endoscopie balloon dilatation of the sphincter of Oddi in patients with suspected biliary dyskinesia: results of a prospective randomized trial. Gastrointest Endose 1986;32:158–162.Google Scholar