ABSTRACT
Objective To explore the impact of juxtapapilary duodenal diverticulum on the formation of choledocholithiasis and biliary manometry after surgery.Methods The clinical data of 97 patients with common bile duct stones who successfully underwent ERCP and biliary manometry treatment from May 2011 to March 2014 were retrospectively analyzed.Ninty-seven common bile duct stone patients were divided to two groups,that is,52 cases of juxta-papilary duodenal diverticulum (experimental group) and 45 cases without juxta-papilary duodenal diverticulum (control group).The biliary manometric results before and after EST of both groups were compared.Results The basal pressure of sphincter Oddi of the experimental group before EST [(84.8 ± 26.1) mmHg] was higher than that of the control group before EST [(75.5 ± 14.6) mmHg] (P ＜ 0.05,1 mmHg =0.133 kPa);and that after EST was also higher than that of the control group after the operation[(19.8 ± 14.2)mmHg VS (15.9 ± 9.8)mmHg,P ＜ 0.05].The biliary pressure of common bile duct stone patients with JPD was higher than those without JPD before and after EST but with no significant difference(P ＞ 0.05).The biliary manometry was performed in 81 patients after one month and it was found that the basal pressure of sphincter Oddi of experimental group was still higher than that of the control group [(34.8 ± 17.1) mmHg VS (29.6 ± 15.3)mmHg,P ＜ 0.05].The biliary pressure of common bile of the experimental group was higher than that of the control group [(19.9 ± 11.2) mmHg VS (17.1 ± 13.1)mmHg,P ＜0.05].Conclusion The existence of juxtapapilary duodenal diverticulum increases the pressure of common bile duct and Oddi sphincter and leads to CBD stones.
ABSTRACT
Objective To investigate the effects of hypercholesteremia on the motor function of sphincter of Oddi (SO). Methods Thirty-two rabbits were divided into control group and experimental groups. In the control group, the rabbits were fed with normal diet. In the experimental groups, the rabbits were fed with normal diet + cholesterol for 4, 6 and 10 weeks. Myoelectric activity and pressures of SO were detected. All data were analyzed by t test. Results The serum total cholesterol and low density lipoprotein cholesterol were at a high level in rabbits which were fed with normal diet + cholesterol for 10 weeks (t=9.63, 11.38, P <0.05); basal pressure, pike pressure and amplitude of SO were significantly elevated (t=5.23, 6.34, 3.24, P < 0.05) ; the spike potential of SO changed to myoelectronic activity, with prolonged time period of myoelectronic activity, while the discharge rate was decreased (t=13.68, 10.18, P < 0.05). Conclusion Hypercholesteremia may change the motor function of SO and enhance its peristalsis to speed up the excretion of bile.
ABSTRACT
Perendoscopic biliary manometry may not represent the overall sphincter of Oddi (SO) motility, as the recording time is relatively short and it is possibly influenced by the presence of an endoscope in duodenum and air inflation. Percutaneous transhepatic biliary manometry of SO permits long-term recordings without patient discomfort and risk of complications. We investigated the change of human SO motility and the correlation between SO motility and migrating motor complex (MMC) of the small bowel in a fasting state by long-term simultaneous manometric examination of SO and small bowel. During long-term manometry, MMC-like cyclic activities of SO were observed, which consiered to be MMC of SO. It coordinated well with MMC of the small bowel, except that SO was not quiescent during phase I MMC of the small bowel. In addition, the basal pressure of SO changed in accordance with the phases of SO motility. Percutaneous transhepatic biliary manometry also permits prolonged manometric studies to investigate normal physiologic reflexes such as gastroduodeno-sphincteric, cholecysto-sphincteric and choledocho-sphincteric reflexes, and the influence of cholecystectomy on SO motility in humans.
Subject(s)
Female , Humans , Male , Middle Aged , Biliary Dyskinesia/diagnosis , Gastrointestinal Motility , Manometry/methods , Muscle Contraction , Myoelectric Complex, Migrating , Pressure , Sphincter of Oddi/physiopathology , Time FactorsABSTRACT
BACKGROUND/AIMS: The conventional treatment of patients with common bile duct (CBD) stones was to insert a T-tube via the duct after stone removal. But since the placement of T-tubes resulted in a lot of complications, a few alternative methods have been suggested lately, such as primary closure or intraductal drainage etc. Deciding whether to perform primary closure or to insert a stent or a T-tube is usually based on objective findings such as inspection, palpation or intraoperative cholangiogram. We made a study using the intraoperative biliary manometry as an objective indicator in decision making among the procedures. METHODS: The study was based on 23 patients (10 male, 13 female) who underwent common bile duct exploration for stone removal from March 2002 to May 2003. The basal pressure and frequency of phasic contraction of the Sphincter of Oddi were measured intraoperatively by manometry RESULTS: Primary closure after CBD exploration was performed in 15 cases, intraductal drainage in the remaining 8 cases. No complication such as bile leakage or postoperative obstructive jaundice was observed. CONCLUSION: The intraoperative biliary manometry is a simple and useful tool that can be used as an indicator in deciding whether to perform a drainage procedure after common bile duct stone removal.