Sphincter of Oddi Dysfunction and the Formation of Adult Choledochal Cyst Following Cholecystectomy: A Retrospective Cohort Study.

To determine the causes underlying the formation of adult choledochal cyst.Anomalous pancreaticobiliary junction is the most widely accepted theory regarding the etiology of choledochal cyst. However, choledochal cysts have been found in patients in the absence of this anomaly. Because the number of adult patients with choledochal cyst is increasing, it is important to address this controversy.Bile amylase levels in the cysts of 27 patients (8 males and 19 females) who had undergone cholecystectomy were retrospectively evaluated.The average age of the 27 patients was 45.8 ± 10.1 years and the majority (85.2%) were diagnosed with Todani type I cysts. None of the patients had dilatation of the common bile duct prior to surgery. There were 6 (22.2%) patients with anomalous pancreaticobiliary junction. However, amylase levels did not significantly differ between patients with and without this anomaly (P = 0.251). According to bile amylase levels, pancreatobiliary reflux was present in 21 (77.8%) patients. The mean amylase level significantly differed in patients with pancreatobiliary reflux (23,462 ± 11,510 IU/L) and those without (235 ± 103 IU/L) (P < 0.001). In patients with pancreatobiliary reflux, only 4 patients had anomalous pancreaticobiliary junction. That is, the majority of patients (17/21, 81%) having pancreatobiliary reflux did not have an anomalous junction of the pancreatic and biliary ducts.Since the only explanation for pancreatobiliary reflux in patients with a normal pancreaticobiliary junction is sphincter of Oddi dysfunction, we proposed that the formation of adult choledochal cyst is mainly due to sphincter of Oddi dysfunction.

Endoscopic approach to the patient with motility disorders of the bile duct and sphincter of Oddi.

Since its original description by Oddi in 1887, the sphincter of Oddi has been the subject of much study. Furthermore, the clinical syndrome of sphincter of Oddi dysfunction (SOD) and its therapy are controversial areas. Nevertheless, SOD is commonly diagnosed and treated by physicians. This article reviews the epidemiology, clinical manifestations, and current diagnostic and therapeutic modalities of SOD.

Frequency of sphincter of Oddi dysfunction in patients with previously normal sphincter of Oddi manometry studies.

BACKGROUND AND STUDY AIMS: Sphincter of Oddi manometry (SOM), performed at endoscopic retrograde cholangiopancreatography (ERCP), is the gold standard for diagnosing sphincter of Oddi dysfunction (SOD). The question remains as to whether the short-term manometric recordings reflect the 24-hour pathophysiology of the sphincter. The aim of this study was to determine the frequency of SOD in persistently symptomatic patients with previously normal SOM studies. PATIENTS AND METHODS: All patients who underwent ERCP for suspected SOD over a 13-year period (1994 - 2007) were considered for inclusion in the study. Patients with an intact papilla and a previously normal SOM who had a repeat ERCP for persistent symptoms formed the study group. SOM was performed in conventional retrograde fashion. RESULTS: In all, 5352 patients without prior papillary intervention underwent SOM during the study period. A total of 1037 patients had normal SOM, and of these, 30 patients (27 female, mean age 40.1 years) underwent repeat ERCP for persistent symptoms. The median duration between the two ERCPs was 493.5 days (range 52-3538 days). In these 30 patients, SOD classification prior to the initial ERCP was: type I in one patient (not treated in 1994), type II in 17 patients, and type III in 12 patients. Of the 30 patients, 12 (40%) had normal SOM at repeat ERCP; SOD was diagnosed in 18/30 (60%) patients. CONCLUSIONS: A single SOM study may not represent the day-to-day physiology of the sphincter of Oddi; sphincter pathology may progress over time. One normal exam may not rule out SOD. A repeat ERCP with manometry may be warranted in a subset of patients with persistent debilitating symptoms and a high index of suspicion for SOD. Outcome data are needed to determine whether this approach justifies the potential risks of ERCP.

Assessment of frequency and safety of endoscopic retrograde cholangiopancreatography in patients over 80 years of age.

INTRODUCTION: Biliary and pancreatic diseases, especially choledocholithiasis and neoplastic diseases, are commonly seen in elderly patients. Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure performed more and more frequently also in elderly patients. OBJECTIVES: The aim of this study was to evaluate the utility and safety of ERCP in patients > 80 years of age. PATIENTS AND METHODS: We retrospectively analyzed 821 ERCP performed in the Department of Gastrointestinal Diseases, Medical University of Lódz in the years 2005-2007. We compared age, sex, clinical symptoms, laboratory findings, ERCP efficacy and safety in patients > 80 years of age versus younger subjects. RESULTS: ERCP was performed in 96 patients > 80 years of age (11.7%). ERCP-related complications occured in 48 (5.8%) patients, including 44 (6.1%) younger and 4 (4.2%) older subjects (p > 0.05). Acute pancreatitis was observed in 34 patients (32 [4.4%] younger and 2 [2.1%] older patients; p > 0.05). In 12 patients gastrointestinal hemorrhage and in 2 patients perforation were diagnosed. There was no statistical difference between the number of complications in the 2 compared patient groups. A mean length of hospital stay was similar in both groups, 4.8 days in the younger, and 5.7 days in older patients (p > 0.05). CONCLUSIONS: ERCP is a safe and effective method for diagnosis and treatment of both elderly and younger patients.

[Functional condition of the hepatobiliary system in patients with biliary dyskinesia].

AIM: To study function of the liver, sphincter system and the gall bladder (GB) in patients with biliary dyskinesia (BD). MATERIAL AND METHODS: Thirty-four patients with BD have undergone clinical, fibrogastroduodenoscopic examinations, fractional duodenal intubation with examination of the bile, ultrasonography, dynamic scintigraphy of the hepatobiliary system. RESULTS: The examination of the patients has detected GB hypotonia (65%), GB hypertension (35%), Oddi's sphincter hypertention (28%), Oddi's sphincter hypotonia (44%), Lutkens' sphincter hypertonicity (19%), Lutkens' sphincter hypotonia (13%), impairment of intrahepatic biliary tracts (65%), lithogenic bile (100%), duodenogastric reflux (41%). CONCLUSION: Consecutive use of duodenal tubing, ultrasonography and hepatobiliscintigraphy provide assessment of defects in the function of the liver, biliary tract and sphincter system in patients with BD.