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Endoscopic Manometry of the Pancreatic and Common Bile Ducts, and Pharmacological Evaluation of Sphincter of Oddi Function with Microtransducer Catheters M. Tanaka 1 , S. Ikeda 1 , H. Yoshimoto 1 , H. Itoh 1 1The First Department of Surgery, Faculty of Medicine, Kyushu University pp.1251-1256
Published Date 1982/11/25
DOI https://doi.org/10.11477/mf.1403108706
  • Abstract
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 With the advent of endoscopic manometry, nonoperative investigation of pancreatic and common bile duct (CBD) pressures and the sphincter of Oddi func-tion has become possible. Pancreatic and CBD pressures were measured with a 2 m long, 4 French 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 four 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 4 m long microtransducer catheter was introduced into the CBD and left in place after removal of the endoscope. The indwelling microtransducer manometry was performed on three patients suspected of postcholecystectomy dyskinesia, and CBD pressure was continuously monitored for 30 min before and 60 min after intramuscular 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.


Copyright © 1982, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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