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Endoscopic manometry of the pancreatic and common bile ducts and pharmacological evaluation of sphincter of oddi function with micro transducer catheters



Endoscopic manometry of the pancreatic and common bile ducts and pharmacological evaluation of sphincter of oddi function with micro transducer catheters



Stomach & Intestine (Tokyo) 17(11): 1251-1256



With the advent of endoscopic manometry, nonoperative investigation of these pancreatic and common bile duct (CBD) pressures and the sphincter of Oddi function has become possible. Pancreatic and CBD pressures were measured with a microtransducer catheter in 77 patients with gallbladder stones (15), CBD stones (39), intrahepatic stones (15) or CBD dilatation (8). A pull-through technique was utilized with the patient on the left lateral position. Anticholinergic or sedative drugs were not used to avoid their possible effects on the pressure values. The pressures showed a biphasic change synchronous to respiration and superimposed by small variations transmitted from arterial pulsation. The CBD-to-duodenum pressure gradient in the intrahepatic stone group was significantly lower than that in the CBD stone group. No significant difference was found between the CBD-to-duodenum gradients of the other groups or between the pancreatic duct-to-duodenum gradients of the 4 disease groups. The pressures were measured before and after endoscopic sphincterotomy in 30 patients, demonstrating significant reduction after the procedure, not only in the CBD-to-duodenum gradient, but also in the pancreatic duct-to-duodenum gradient. For continuous pressure recording for a longer period, a microtransducer catheter was introduced into the CBD and left in place after removal of the endoscope. Indwelling microtransducer manometry was performed on 3 patients suspected of postcholecystectomy dyskinesia and CBD pressure was continuously monitored for 30 min before and 60 min after i.m. administration of 10 mg of morphine. Morphine reproduced pain, while the CBD pressure rose and the pressure waves became irregular in shape and high in amplitude, the degree of these pressure changes being well related to the intensity of the pain. Since spasm of the sphincter of Oddi was considered to be responsible for the pain and the pressure changes, endoscopic sphincterotomy was performed with complete relief of the symptoms. A repeat morphine-induced pressure measurement after the sphincterotomy confirmed the disappearance of the pain and the irregular waves.

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Accession: 005359373

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