Search

Background: Bile duct microenvironment plays several key roles in cholangiolithiasis occurrence. Sphincter of Oddi laxity (SOL) is associated with cholangiolithiasis, probably due to enhanced reflux of intestinal contents that changes the microenvironment. However, the microenvironment has not been investigated comprehensively., Study Design: Patients with cholangiolithiasis were consecutively recruited and their bile was collected intraoperatively for high-throughput experiments. Pyrosequencing of 16S ribosomal RNA gene was performed to characterize the microbiota in the bile. A liquid chromatography mass spectrometry-based method was used to profile bile composition. Clinical manifestation, microbiome, and bile composition were compared between patients with and without SOL., Results: Eighteen patients with SOL and 27 patients without SOL were finally included. Patients with SOL showed more severe inflammation. Bacteria in the bile duct were overwhelmingly aerobes and facultative anaerobes. Proteobacteria and Firmicutes were the most widespread phylotypes, especially Enterobacteriaceae. Compared with those without SOL, patients with SOL possessed more varied microbiota. In the SOL group, pathobionts, such as Bilophila and Shewanella algae had richer communities, and harmless bacteria were reduced. Metabolomics analysis showed the differences in bile composition between groups were mainly distributed in lipids and bile acids. Particularly, the increased abundance of Bilophila involved in taurine metabolism was associated with reduced contents of taurine derivatives in the bile of patients with SOL., Conclusions: A bile duct microenvironment with more severe bacterial infection and stronger lithogenicity was found in patients with SOL. The findings suggest a possible mechanism of cholangiolithiasis and provide the basis for future strategies for prevention of cholangiolithiasis recurrence., (Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the relationship between anatomic abnormalities and malfunction of Oddi sphincter with formation of bile duct pigment gallstone., Methods: One hundred and twenty-three patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group by measuring the amounts of radioactivity of (99m)Tc-DTPA in the bile. Among them 53 were selected randomly to undergo choledochoscopic manometry. Basal pressure of Oddi's sphincter (SOBP), amplitude of Oddi's sphincter (SOCA), frequency of contraction (SOF), duration of contraction (SOD), duodenal pressure (DP), common bile duct pressure (CBDP) were scored and analyzed. The level of plasma motilin and serum gastrin of 45 patients and 12 healthy volunteers were measured by radioimmunoassay. The incidence rates of duodenal descending part diverticulum in patients with bile duct pigment stones, patients without alimentary tract diseases, patients with gallbladder polyps, patients with gallbladder stones were studied by means of barium meal examination. The incidence rates of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stones, patients with bile duct stone and gallbladder stones, patients with bile duct stones originating from the gallbladder, patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla, patients with post-cholecystectomy syndrome were detected by duodenoscope., Results: Of the patients, 44 were detected with duodenal-biliary reflux (35.8%). SOBP, SOCA and CBDP in the reflux group were much lower than those in control group (P < 0.001). The level of serum gastrin and plasma motilin of the reflux group were much lower than those of control group (P < 0.01). Positive correlation was found between level of motilin and SOBP while level of gastrin was positively correlated with SOBP and CBDP. The incidence of duodenal diverticulum in patients with bile duct pigment stone was 36.62%, which was higher than that of the other 3 groups. The incidence rate of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stone was higher than that of patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla and patients with bile duct stones originating from the gallbladder., Conclusions: The patients with bile duct pigment stone have apparent duodenal-biliary reflux and infection of the bile duct. The state of structure and function of Oddi's sphincter is correlated significantly with bile duct pigment stone. The anatomic abnormalities and malfunction of Oddi's sphincter played an important role in the formation of bile duct pigment stone.

Clinical and surgical observations confirm that acute cholecystitis (ACh) and acute biliary pancreatitis can coexist and that differentiation may be difficult even at surgery. Synchronous appearance of ACh and acute biliary pancreatitis suggests a similar etiology. Endoscopic sphincterotomy, with relief of the common channel outlet obstruction, has become the established therapeutical modality that improves the outcome in acute biliary pancreatitis. Patients suffering from ACh could be treated in a similar manner to prevent reflux of pancreatic juice into the common bile duct and the gallbladder with the intention to improve the clinical course. The present study investigated the presence and amount of pancreatic trypsin in the gallbladder bile in 73 patients operated on for gallstone disease with ACh and in controls. The average gallbladder bile trypsin level in the "edematous cholecystitis" group ranged between 0.525 and 4500 ng/mL, significantly exceeding that of controls, 0.5-53 ng/mL (P < 0.0001). The average gallbladder bile trypsin level in the "gangrenous cholecystitis" group, 0.1-71.5 ng/mL, was within the range of controls (n.s.), most likely to be explained as a consequence of consumption of trypsin due to the fulminant development of the disease. Further controlled studies are mandatory before it would be acceptable to recommend endoscopic sphincterotomy as a valuable choice in the initial/early management of patients suffering from ACh. Such a study is underway to assess the possible role of obstruction at, or other disorders of, the sphincter of Oddi with consequent pancreatic juice reflux into the gallbladder as a possible initial cause of ACh.

Bile duct crystals collected either from the duodenum after gallbladder contraction or directly from bile duct aspiration are surrogates for gallbladder stones and microlithiasis. Whether bile crystals also serve as surrogates for bile duct stones or microlithiasis that forms in the bile duct after cholecystectomy is not known based on current data. Sphincter of Oddi dysfunction (SOD), due either to muscular spasm or sphincter fibrosis, is a cause of bile duct obstruction. Almost all of the literature on SOD involves patients who have had a prior cholecystectomy. Intuitively, obstruction at the SO following cholecystectomy would seem to lead to biliary stasis and predispose patients to bile duct microlithiasis. However, a recent study did not find bile duct crystals in patients with manometrically diagnosed SOD. The reason for this is unknown, although we hypothesize that cholesterol and bilirubinate crystals are not surrogates for brown pigment stones commonly found in patients following cholecystectomy.

Objective: To evaluate the effects of truncal vagotomy at the diaphragmatic level on the sphincter of Oddi (SO) motility., Summary Background Data: Cholelithiasis is a well-known late complication after gastrectomy and/or vagotomy. The mechanism of gallstone formation is only partly understood, and few studies address the effects of vagotomy on SO cyclic motility in conscious subjects., Methods: In conscious dogs, SO motility was recorded by retrograde infusion manometry through a duodenal cannula before and after bilateral truncal vagotomy at the diaphragmatic level. Effects of cholecystokinin-octapeptide and feeding were also evaluated before and after vagotomy., Results: SO cyclic motility and the gastroduodenal migrating motor complex continued to occur during postvagotomy fasting. Intermittent inhibitions of the SO and duodenal contractions disappeared during phase 3 of the migrating motor complex. SO basal pressure significantly decreased, whereas the amplitude significantly increased. Cholecystokinin-octapeptide inhibited SO contractions before and after vagotomy. The amplitude of SO contractions increased and their frequency decreased after feeding; however, these effects disappeared after vagotomy., Conclusions: SO cyclic motility and the effects of feeding change after truncal vagotomy at the diaphragmatic level. These facts may at least partly explain gallstone formation after gastric surgery and/or vagotomy.

Background: Somatostatin has been used to prevent pancreatitis after endoscopic retrograde cholangiopancreatography but its effect on acute non-biliary pancreatitis is still unclear., Aim: The purpose of this study was to evaluate the function of the sphincter of Oddi (SO) and the effect of somatostatin on patients with non-biliary pancreatitis., Methods: Twenty patients (18 males, two females) with acute pancreatitis (alcoholic 18, idiopathic two) received SO manometry within one week after admission. After baseline measurement, a bolus dose of somatostatin (Stilamin, Serono) 250 microg was infused slowly, and SO manometry was repeated after five minutes. Continuous infusion of somatostatin 250 microg/h was given for 12 hours after SO manometry. Serum amylase, lipase, glucose, and C reactive protein (CRP) levels were examined before and after somatostatin infusion., Results: SO manometry was unsuccessful in six patients due to contracted sphincter. In the remaining 14 patients, high SO basal pressure (SOBP >40 mm Hg) was found in seven patients. After somatostatin infusion, mean SOBP decreased from 48.8 (29) to 31.9 (22) mm Hg (p<0.01). One patient had a paradoxical reaction to somatostatin (SOBP increased from 30 to 50 mm Hg) while the other 13 patients had a fall in SOBP after somatostatin. One patient developed abdominal pain with a serum amylase level of 2516 IU/l after SO manometry. No other side effects or changes in amylase, lipase, glucose, or CRP levels were observed in the other 19 patients after SO manometry and somatostatin infusion., Discussion: Sphincter of Oddi dysfunction is common in patients with acute non-biliary pancreatitis and in most cases somatostatin can relax the sphincter.

Background and Aims: Even if the motor activity of the gall bladder and sphincter of Oddi (SO) are integrated, it is not known if the presence of stones in the gall bladder affects SO function. The aim of the study was to compare SO motor activity in patients with and without gall stones., Patients and Methods: In a series of 155 patients consecutively submitted to endoscopic retrograde cholangiopancreatography and SO manometry for suspected biliary or pancreatic disease, 23 gall stone patients had recurrent episodes of biliary or pancreatic pain (colicky group); 52 patients had non-biliary/pancreatic-type abdominal pain/discomfort, and of these, 15 had gall stones (non-colicky group), 25 were free of stones (controls), and 12 had undergone cholecystectomy., Results: SO basal pressure in gall stone patients in the colicky or non-colicky group was significantly higher than in controls (p<0.001). SO basal pressure recorded in postcholecystectomy patients did not differ from controls. SO phasic activity did not differ between the patient groups. SO dysfunction was detected in more than 40% of gall stone patients irrespective of associated biliary/pancreatic pain but in none of the control subjects (p<0.001)., Conclusions: Gall stones are frequently associated with increased SO tone which may obstruct bile flow thus acting to facilitate gall bladder stasis, and may play a role as a cofactor in biliary/pancreatic pain.

The purpose of this study was to explore a difference in sphincter of Oddi (SO) motor activity among patients with intrahepatic (I, N = 5), intra- and extrahepatic (IE, N = 15), and common bile duct (CBD, N = 6) stones. Interdigestive motility of the SO and duodenum was studied by pneumohydraulic infusion manometry via the percutaneous route. SO phasic contractions showed a cyclic change in concert with the duodenal migrating motor complex (MMC) in all these patients. There was no significant difference in the cycle length, frequency, or amplitude of the SO phasic waves among the three groups throughout the whole cycle. The SO basal pressure during duodenal phases I and II of the duodenal MMC was significantly lower in patients with the IE type of hepatolithiasis than in those with the I type (P = 0.04), but there was no significant difference during phase III between the two groups. The SO basal pressure during phases I and II of the CBD group was also significantly lower than that of the I group (P = 0.02). The significance became even more prominent (P = 0.001) when a subgroup of patients with a dilated CBD (diameter > 1 cm) was examined. Lower basal pressure in the IE group or CBD group than in the I group suggested that stones in the common duct might injure or irritate the SO and cause SO dysfunction. In the subgroup with dilated CBD, which may have resulted from repeated and severe SO injury, the statistics became more prominent.

Background and Study Aims: In animal studies cholecystectomy has been found to alter the normal effect of cholecystokinin (CCK) on sphincter of Oddi (SO) function. This could be of importance with regard to the development of postcholecystectomy biliary pain. We therefore investigated the effect of laparoscopic cholecystectomy on SO motility before and after infusion with CCK., Patients and Methods: A prospective study of SO motility, under basal conditions and during CCK (ceruletide) infusion, was carried out in eight women with uncomplicated gallstone disease, before and after laparoscopic cholecystectomy., Results: Laparoscopic cholecystectomy increased common bile duct pressure (P = 0.01) and decreased the frequency of phasic contractions (P=0.05). However, the inhibitory effect of CCK was preserved as infusion of CCK was associated with a significant reduction in SO phasic amplitude and frequency, both before and after cholecystectomy., Conclusions: Following laparoscopic cholecystectomy an indisputable inhibitory effect of CCK in the SO was found. Common bile duct pressure increased and minor modifications in basal SO motility were seen.

Background: Gall bladder and sphincter of Oddi (SO) function are coordinated by hormonal and neuronal mechanisms. Nerve fibres pass between the gall bladder and the SO via the cystic duct. It is therefore possible that cholecystectomy may alter SO motility., Aim: To investigate the effect of cholecystectomy on SO function., Methods: SO manometry was performed in five women (median age 52 years), a few days before and six months after laparoscopic cholecystectomy which was undertaken for uncomplicated cholelithiasis. Basal and post-cholecystokinin (CCK) SO motility were measured., Results: All patients were symptom free after laparoscopic cholecystectomy. Prior to surgery common bile duct pressure, and tonic and phasic SO motility were normal and phasic contractions were inhibited by intravenous CCK (1 Ivy Dog Unit/kg). Six months later, common bile duct pressure and baseline tonic and phasic activity were unchanged but CCK failed to suppress phasic activity., Conclusion: Cholecystectomy, at least in the short term, suppresses the normal inhibitory effect of pharmacological doses of CCK on the SO. The mechanism of this effect is unknown but it could be due to SO denervation.

In a previous study, we have shown that caerulein relieves biliary colic pain in gallstone patients. This study was initiated to determine gallbladder and sphincter of Oddi behaviour during biliary colic and their response to caerulein. In 10 gallstone patients gallbladder volume was measured by real-time ultrasonography during a biliary colic episode and 72 hours after cessation of pain, before and after caerulein administration. Basal sphincter of Oddi pressure was determined by CPRE manometry in 10 gallstone patients during biliary colic and three days after cessation of pain, before and after caerulein. The results of this study show that, during biliary colic, gallbladder volume is 8 times greater than in the post-colic state. Basal sphincter of Oddi pressure was also significantly higher during biliary colic than in the post-colic state. Caerulein relieved in all cases the biliary colic pain while reducing gallbladder volume and decreasing the sphincter of Oddi.

Objectives: The sphincter of Oddi (SO) manometry via the transpapillary route is performed usually for a period of several minutes. To investigate whether there is a considerable variation in the manometric measurements of SO over a longer period of time, we have performed long-term manometry of SO via the transpapillary (n = 5) as well as the percutaneous (n = 7) routes., Methods: Transpapillary manometry of SO was carried out by a conventional low-compliant continuously perfused technique. The location of the manometric catheter was maintained at the same level by observing the video monitor. SO manometry and the duodenal migrating motor complex (MMC) was simultaneously measured with a specially designed catheter via the percutaneous route., Results: The mean recording time was 41 min (range 11-72 min). The frequency of phasic contractions of SO varied from 0 to 12/min. Throughout the entire recording period, high-frequency contractions (over 8/min) were noted 14.9% of the time. In the cases of percutaneous transductal SO manometry, the periods of high-frequency contractions coincided with phase III of duodenal MMC. The interval between the first high-frequency contractions and the second was 47 min. The mean duration of high-frequency contractions was 6 min and 42 s. There was no significant change in the amplitude, basal pressure, and contraction sequence among the various periods of frequencies., Conclusions: Long-term continuous recording of SO manometry via the transpapillary and percutaneous routes showed that the contraction frequency of SO was not constant and tachyoddia appeared periodically. In the interpretation of tachyoddia, it is necessary to consider the period of phase III of the duodenal MMC.

Intraluminal pressure of sphincter of Oddi (SO) was measured in awake patients who had undergone cholecystectomy and T-tube drainage for cholecystocholedocholithiasis. Pressure measurement was carried out using microtransducer which was inserted through sinus tract under cholangioscopy after removing T-tube. Mean value of the basal pressure was 12.0 +/- 1.5 mmHg, the amplitude of the phasic contraction was 55.2 +/- 4.4 mmHg and the frequency of the phasic contraction was 4.2 +/- 0.3 cycle/min. Intravenous administration of caerulein or atropine caused marked decrease in the amplitude and the frequency of the phasic contraction of SO, whereas pentazocine caused marked increase in the basal pressure, the amplitude and the frequency of the phasic contraction of SO. Naloxone alone did not affect the phasic contraction of SO, but it reduced the increased amplitude and frequency of the phasic contraction of SO caused by pentazocine. In conclusion, cholinergic nerves, excitatory nerves mediated by opioid receptors and non-cholinergic non-adrenergic inhibitory nerves may modulate spontaneous motor activity of human sphincter of Oddi.

The trypsin level in bile was studied by radioimmunoassay in a prospective series of 63 patients with gallstone disease but without signs or symptoms of cholecystitis or pancreatitis in order to find indirect evidence of a retrograde flow of pancreatic juice. Mobile duct stones were present in 18 patients and impacted stones in 12. The remaining 33 patients had stones only in the gallbladder and served as controls. The average intraoperative trypsin level of the ductal bile was normal, both in the control group and in the group with stones occluding a potential retrograde reflux of pancreatic juice. After removal of the impacted stones, the bile showed a significantly higher trypsin level. The average intraoperative trypsin level for the group with mobile stones was significantly higher than that of the control group, and was further increased 10 days postoperatively. The trypsin level of ductal bile from 23 of the 30 patients (77%) with bile duct stones exceeded that of the 33 patients with stone-free bile ducts, indicating an inflow of pancreatic juice to the bile ducts of patients with bile duct stones. The present results correspond well to those in a previous report on retrograde phasic contractions of the sphincter of Oddi in the majority of patients with bile duct stones. This dysfunction of the sphincter, which persisted for 10 days after surgical stone removal, may be the primary disorder, probably consisting of a retrograde propulsive activity of the sphincter of Oddi.

The motility of the sphincter of Oddi was measured by percutaneous transhepatic manometry of the sphincter of Oddi (PTMSO) in three groups of 57 patients with bile duct stones. The three groups were: (1) cholecystectomy group (N = 10)--patients with common bile duct stones (CBDS) who had already undergone cholecystectomy; (2) noncholecystectomy group (N = 37)--patients with CBDS who had not undergone cholecystectomy; and (3) intrahepatic stone (IHS) group (N = 10). The basal pressure, amplitude, frequency, and propagation direction of contraction waves and the response to cerulein injection or dried egg yolk ingestion were analyzed and compared among these groups. No significant differences in the basal pressure, amplitude, frequency, and propagation direction of the contraction waves were found among the three groups. There were also no differences in the response to cerulein or dried egg yolk ingestion. The frequency and duration of the burst contractions occurring in duodenal phase III of the migrating motor complex were significantly higher (P < 0.05) in the cholecystectomy group than in the other two groups. These two differences in the burst contractions may be ascribed to the absence of the gallbladder.

We have investigated whether stenosis or insufficiency at the duodenal papilla results from the passage of a gallstone through the biliary tract. In three groups of patients after cholecystectomy we studied meal-stimulated pancreatic enzyme activity in T-drain bile from the common bile duct. Group A had gallbladder stones only; group B had gallbladder stones and bile duct stones; and group C had an episode of acute gallstone-induced pancreatitis, which was taken as direct evidence for gallstone migration into the duodenum. Reflux of pancreatic juice into the common bile duct was absent in group A, was occasionally found in group B, and was strikingly increased in group C. We conclude that passage of a gallstone through the biliary tract causes functional stenosis of the sphincter of Oddi and allows for a common channel between the pancreatic duct and the common bile duct. It does not cause sphincter insufficiency as previously assumed.

Endoscopic manometry using microtransducer was applied to evaluate the motor activity of the sphincter of Oddi (SO) and common bile duct (CBD) in patients with biliary tract stones and in controls. CBD pressure, SO pressure and the incidence of irregular phasic wave pattern (IRPWP) were relatively higher in patients with biliary tract stones than those in controls. There was no significant difference in CBD and SO pressure between patients with dilated CBD and patients with non-dilated CBD, however the incidence of IRPWP was significant higher in patients with dilated CBD than that in patients with non-dilated CBD. SO pressure and the incidence of IRPWP were significant higher in patients with papillitis than those in patients without it. Patients with valvular orifice of the papilla of Vater showed high incidence of IRPWP, and in such cases it was suggested that SO had different motor functions for CBD and pancreatic duct because these ducts were seen opening onto the papilla separately according to the findings of pancreatocholangiogram. We concluded that endoscopic manometry of CBD and the SO was useful to evaluate the motor activity of SO and provided a basis for the assessment of the motor function mechanism of SO. Our results indicated the motor activity of SO had close relationship with biliary tract stones, CBD dilatation and endoscopic findings of the papilla of Vater.

We used a catheter passing through the papilla duodeni under the view of endoscope, with persistent perfusion system and transducer, to measure the pressure and contraction frequency of sphincter of Oddi (SO) in 10 healthy persons and 20 patients. Meanwhile, we compared the effect of Buscopan, Nitrostat and Vitamin K3 on the pressure and contraction frequency (CF). SO basal pressure (BP) in healthy group was 5.21 +/- 1.61 kPa (mean +/- s), SO peak pressure (PP) 8.21 +/- 1.34 kPa and CF 6.14 waves/min. In the group of peripapillary fistula, SO pressure decreased significantly and CF slowed down greatly. In comparison with the healthy group, SO pressure and CF in the group of gallbladder stone, choledocholithiasis and pancreatic diseases did not show any change of statistic significance. Intravenous injection of Buscopan could decrease SO peak pressure and BP remarkably. Sublingual administration of Nitrostat and intramuscular injection of Vit K3 could reduce SO PP markedly, SO BP didn't change statistically. It was also showed that spheric and semi-spheric papillae had higher pressure than the flat ones (P less than 0.001).

A nonoperative examination of the function of the sphincter of Oddi, involving percutaneous transhepatic manometry via the percutaneous transhepatic biliary drainage tract, was developed and clinically applied in 23 patients with biliary disease. Long-term recording of sphincter of Oddi motility, which was impossible using conventional intraoperative or endoscopic manometry, was made possible by means of this method and revealed various changes of sphincter of Oddi motility. The mean recording time was 131.33 +/- 9.77 min. The frequency of contractions of the sphincter of Oddi in basal fasting conditions varied from 0 to 13/min and high-frequency contractions (frequency 9.49 +/- 0.35/min, duration 5.77 +/- 0.54 min) were observed in 12 patients on a total of 19 occasions. In five patients, high-frequency contractions were observed twice during one session of continuous recording and the interval between burst contractions was 85.4 +/- 13.3 min. Long-term continuous recording is advantageous for the evaluation of the function of the sphincter of Oddi and short-term manometry may not be representative of overall sphincter of Oddi motility.

In seven patients operated on with cholecystectomy for simple gallstones, sphincter of Oddi manometry was performed during surgery. The sphincter was localized as a zone with elevated base-line pressure and phasic contractile activity. Mean value of the amplitude was 90 mm Hg; wave duration, 4 sec; frequency, 5/min; and base-line pressure, 10 mm Hg. No activity was seen in the antrum or duodenum. The plotting of peak-to-peak intervals in a histogram showed that these were evenly distributed around 6 sec or at integrated multiples of this value. This indicates that the sphincter of Oddi is paced. The origin of the pacing is not yet established.

Sphincterotomy has previously been shown to decrease gallbladder volume and gallbladder bile stasis while inhibiting gallstone formation in the prairie dog. We tested the possibility that atropine administration might reverse the effects of sphincterotomy on gallbladder mechanical function and gallbladder bile stasis and thereby reverse the inhibition of gallstone formation seen after sphincterotomy. Sixteen prairie dogs underwent sphincterotomy and were placed on a high cholesterol diet known to consistently induce gallstone formation. After 6 wk, in addition to the lithogenic diet, 8 animals were administered atropine. A control group of 8 animals was continued on the lithogenic diet. At death, animals that had undergone sphincterotomy and received atropine had a larger mean gallbladder volume (2.7 +/- 0.4 ml) than sphincterotomized control animals (0.66 +/- 0.2 ml, p less than 0.005), more total lipid stored in the gallbladder (176.1 +/- 33.9 mumol, sphincterotomy and atropine vs. 42.8 +/- 17.3 mumol, sphincterotomy, p less than 0.005), and a larger fraction of administered radiolabeled bile salt stored in the gallbladder (51.5 /- 7.3%, sphincterotomy and atropine vs. 24.5 +/- 10.7 sphincterotomy, p less than 0.05). The ratio of the fraction of [3H]cholic acid in the gallbladder (given 1 day before death) to the fraction of [14C]cholic acid in the gallbladder (given 4 days earlier) was lower for animals that underwent sphincterotomy and received atropine (0.63 +/- 0.04) than for sphincterotomized control animals (1.0 +/- 0.15, p less than 0.05), indicating a return of gallbladder bile stasis in the atropine-treated group. Confirming our previous work, only 1 of 8 animals that underwent sphincterotomy had gallstones. In contrast, 8 of 8 atropine-treated animals formed stones (p less than 0.005). Gallbladder bile of both groups were equally supersaturated with cholesterol. These findings provide direct support for the role of gallbladder bile stasis in the pathogenesis of cholesterol gallstone formation in this model.

We investigated the mechanism of humoral control of bile discharge into the duodenum. The actions of the GB, SO and duodenum were monitered by cinecholecystocholangiogrphy combined with manometry of the SO area using a hydraulic-capillary infusion system or MIKRO-TIP, and these were correlated with the plasma concentrations of GI hormones. We concluded that one of the most significant roles of the sphincter of Oddi is to limit bile flow. This postulation was favored by the observation of so-called 'spasm' of the SO where 8 to 10 contractions per min., in contrast to 'normal' contraction of 2 to 4 per min., were seen. On this special occasion, no discharge of the contrast material into the duodenum was noticed. Exogenous or endogenous CCK causes a coordinated action of the GB contraction, the SO relaxation and relaxation of the adjacent segment of the duodenum, resulting in an effective discharge of bile into the duodenum. The effect of Pancreozymin on bile discharge revealed by endoscopic cinematography was that Pancreozymin first made the orifice of the papilla of Vater widely open with a profuse bile flow and following this, caused a repeated shuttering action of the orifice with minimal discharge of bile. This observation opposes the opinion that active SO contractile activity is necessary to bile flow into the duodenum. Caerulein or CCK-33 caused no 'post-inhibition' enhancement of the SO activity that was seen in case of Pancreozymin administration. Motilin, calcium or other substances contained in Pancreozymin (Boots) might be causative for this enhancement.

The functional activity of the sphincter of Oddi complex has been examined by ceruletide manometry in patients undergoing cholecystectomy with a normal peroperative cholangiogram. In Group I (n = 14), which included patients with previous acute cholecystitis/biliary colic, the sphincter activity appeared to be normal and responded to intravenous ceruletide by a marked relaxation with a significant fall in both the infusion and postinfusion pressures. In patients undergoing cholecystectomy for gallstone-associated pancreatitis (n = 8), the sphincter exhibited manometric features of hypotonia with low infusion and postinfusion pressures which were not significantly altered by intravenous ceruletide.

With the aid of 14 patients, it was attempted to develop a normal curve for pressure conditions at Oddi's sphincter and in the choledochus duct. However, because of limited patient material, it was not possible to interpret deviations from the normal curve and relate these to confirmed pathological conditions.

In 36 cases with gallstones, biliary scintigraphy was performed before and after operation to prepare the time-activity curve in the juxta-papillary duodenum. This curve showed different patterns depending on the conditions of disease, and seemed to represent on aspect of the sphincter of Oddi phasic activity, in view of the exerted effect of caerulein administration. This method is useful as a non-invasive one for the diagnosis of dynamic function of the sphincter of Oddi.

Intraluminal manometric and cine-cholangiomanometric studies were carried out on the movement of the sphincter of Oddi at the time of excretion of bile into the duodenum in 12 patients after cholecystectomy for gallstone. Two phases were observed in the sphincteric movement; the resting phase without any contraction and active phase with vigorous contraction. On stimulation with CCK-PZ 0.5 u/kg (bolus injection) in a active phase, a prompt transition from the active phase to the resting phase was observed in 4 to 8 minutes. On cine-cholangiomanometric study, the contrast medium injected into the common bile duct did not flow into the duodenum at the resting phase, but in the active phase. In the active phase, the excretion of the contrast medium was observed at the end of each contraction of the sphincter of Oddi. These observations have led a conclusion that bile excretion occurs in the active phase of the sphincter of Oddi in the cholecystectomized patients.

By using hepatobiliary scintigraphy, function of the sphincter of Oddi in 88 patients undergoing cholecystectomy with or without common bile duct exploration and T-tube drainage for gallstone disease was studied. These patients consisted of three groups; 57 patients with gallbladder stones (Group I), 25 with common duct stones migrated from the gallbladder (Group II) and 6 with primary common duct stones (Group III). Time-activity curves (T-A curve) obtained from the region of terminal end of the common bile duct were classified into 4 types which were different from each other. On the T-A curve, the rate of decrease (ROD, %) was defined as the difference between the count rate in the maximum and that at the 20 min after the maximum. The ROD in Group I was significantly greater than that in Group II or III (p less than 0.01). The ROD in Group II was also significantly greater than that in Group III (p less than 0.05). The increase of ROD in Group III after cholecystokinin-pancreozymin administration was less remarkable as compared with that in Group II. Thus, we conclude that the function of the sphincter of Oddi in these three groups may be different from each other.

To determine the significance of manometric pressure, measurements of the sphincter of Oddi in a control group and in patients with cholelithiasis with common duct stones with and without recurrent pancreatitis were studied. Sphincter of Oddi pressure was recorded continuously and by station pull-through by a triple lumen catheter. The basal sphincter of Oddi pressure, the mean pressure gradient between common duct and duodenum, and the sphincter of Oddi wave amplitude were measured. There was no significant difference between control subjects and patients with gallstones and common duct stones. In patients with common duct stones and recurrent pancreatitis the basal sphincter of Oddi pressure, the pressure gradient between common duct and duodenum, and the wave amplitude were significantly increased over control patients. These studies suggest that abnormalities in the sphincter of Oddi motor function are more common in patients with common duct stones with recurrent pancreatitis than in similar patients without pancreatitis.

Duodenoscopic manometry of the pancreatic duct (PD) and common bile duct (CBD) using a microtransducer catheter was distinct advantages over infusion manometry, giving absolute values of in situ intraluminal pressure. Microtransducer manometry was performed without medication in 49 patients with gallbladder stones (10), common bile duct stones (24), hepatic duct stones (6) and common bile duct dilatation (9), and was successful in 42 (86%) for PD and 36 (73%) for CBD. Ductal pressures showed respiration-synchronized biphasic variations superimposed by the arterial pulsation effect. Considerable postural change of the pressure values suggested that the recording posture should be predetermined. The PD-to-duodenum pressure gradient was higher than the CBD-to-duodenum gradient in most cases. Both were lower than those obtained previously by infusion methods. No significant differences were found in pressure profiles of the four disease groups. Endoscopic sphincterotomy significantly reduced not only CBD pressure but also PD pressure.

We endoscopically measured pressures of the pancreatic duct (PP) and the sphincter of Oddi (SO) in patients with alcoholic (ALCP, n = 10), gallstone-associated (GSCP, n = 7), and idiopathic chronic pancreatitis (ICP, n = 21), and in 20 controls. The PP was significantly higher in the patients with ALCP (55.7 +/- 28.9 mm Hg), GSCP (33.6 +/- 16.2 mm Hg), or ICP (44.5 +/- 25.8 mm Hg) than in the controls (16.2 +/- 8.7 mm Hg), but there was no significant difference between ALCP, GSCP, and ICP. There was no significant difference between control subjects and ICP in the motility of SO. In ICP, there was no correlation between the PP and the motility of SO. In ALCP and GSCP, the frequencies of the papillary sphincter waves were significantly higher than in normal subjects, and there were correlations between the PP and the motility of SO. These data suggest that increased pancreatic ductal pressure in GSCP with papillitis or ALCP may be due in part to papillary dysfunction, but not in ICP.

Intraluminal pressure recordings from the sphincter of Oddi (SO) have made significant contributions towards the understanding of normal SO function and are being used for the diagnosis of SO motility abnormalities. In this study the endoscopic intraluminal methods for measuring SO pressure changes have been adapted for use under sterile conditions during surgery on the biliary system. Sphincter of Oddi pressure measurement in a group of patients undergoing elective cholecystectomy for gallstones, were compared with a group of control subjects undergoing endoscopic study of the SO. There was no significant difference in CBD pressure. SO basal pressure, SO wave amplitude and SO wave frequency. However, a highly significant difference was noted in the propagation direction of the SO contractions. The control subjects had a predominance of antegrade contractions whereas patients undergoing cholecystectomy had a predominance of retrograde contractions. This result suggests an association between SO motility disorder and the presence of gallstones.

We recorded the pressure of Oddi's sphincter (SO) in 54 patients with gall stones and 25 patients as controls who had no biliary disease. Endoscopic manometry used in this study recorded the dynamic changes of the intraluminal pressure of SO as well as the static pressure of the common bile duct. It was found that in control group, common bile duct pressure was 1.54 +/- 0.15 kPa, basic pressure of SO 2.12 +/- 0.22 kPa, SO-bile duct pressure difference 0.58 +/- 0.07 kPa, and SO peak pressure 5.56 +/- 0.47 kPa, respectively. There was no significant difference between patients with gallbladder stones and secondary cholelithiasis and those in control group. But the pressure of SO was significantly lower in patients with primary bile duct stones than that in controls. This phenomenon indicates that in such patients the contraction strength of SO is weak or lost. This may explain retrograde cholangitis often seen in some patients. We suggest that in order to prevent retrograde cholangitis, adequate procedure should be taken in operation on patients with functional impairment of SO.

The sphincter of Oddi (SO) is critically located at the junction of the common bile duct (CBD), main pancreatic duct, and the duodenum. It is a high-pressure zone with phasic contractions that regulate bile and pancreatic juice flow. The SO is probably regulated by several gastrointestinal hormones, and its basal pressure and phasic contractions can be elevated or decreased significantly by exogenous drugs. Its role in gallstone formation is probably negligible, but severing the SO allows one to extract CBD stones with an endoscope. Abnormal function of the SO can cause biliarylike pain. Of patients with persistent pain after cholecystectomy, 14% have abnormal SO manometric findings. Endoscopic or surgical sphincterotomy can cure these patients of their pain. The SO may play a significant role in the development of pancreatitis in certain patients, either because of the relationship of the CBD orifice to the pancreatic duct orifice created by the SO or because of the response of the SO to exogenous agents, such as alcohol.