Impact of motilin, neurotensin and nitric oxide synthase on sphincter of Oddi dysfunction / 中华消化内镜杂志

Objective To investigate the impact of motilin(MTL), neurotensin(NT)and nitric oxide synthase(NOS)on Oddi sphincter(SO)motion after cholecystectomy. Methods Oddi sphincter manometry(SOM)was performed on both Guinea pig model group(cholecystectomy)and control group (laparotomy)12 weeks after operation. Sphincter of Oddi dysfunction(SOD)group was determined by receiver operating characteristic(ROC)curve analysis and area under curve(AUC). Protein expression of MTL, NT and NOS in SO was also detected through integral optical density method. Meanwhile,the contents of MTL and NT in patients′ plasma of both SOD group(SO pressure> 40 mmHg)and control group were compared. Results AUC of 0.75 and SO pressure of more than 29.8 mmHg was determined as the standard of SOD group.MTL and NT contents(193.16±29.2 pg/mL and 104.57±19.52 pg/mL,respectively)of the model group(n=10)in plasma were significant higher than those of control group(n=11)(154.24 ± 27.69 pg/mL and 79.65±11.24 pg/mL,respectively),and same trend of MTL and NT protein expression in SO was detected(3 556.71±455.80 and 6 321.74±203.54 of the model group;3 075.92±350.06 and 5 843.57±344.00 of the control group).While NOS protein expression in model group was lower than that of the control group(2 954.21± 173.54 VS 3 314.91± 246.67, P<0.05). In clinical research, the plasma contents of MTL(350.98 ± 24.31 pg/mL VS 319.56 ± 23.54 pg/mL)and NT(102.39 ± 19.56 pg/mL VS 80.45±12.35 pg/mL)in SOD group(n=15)were higher than those of the control group(n=15)(P<0.05). Conclusion MTL and NT contents in plasma and protein expression of MTL, NT and NOS in SO may be related to SOD. MTL and NT examinations may assist diagnosing SOD after cholecystectomy.

Sphincter of Oddi Manometry: Reproducibility of Measurements and Effect of Sphincterotomy in the EPISOD Study

BACKGROUND/AIMS: The reproducibility of sphincter of Oddi manometry (SOM) measurements and results of SOM after sphincterotomy has not been studied sufficiently. The aim of our study is to evaluate the reproducibility of SOM and completeness of sphincter ablation. METHODS: The recently published Evaluating Predictors and Interventions in sphincter of Oddi dysfunction (EPISOD) study included 214 subjects with post-cholecystectomy pain, and fit the criteria of sphincter of Oddi dysfunction type III. They were randomized into 3 arms, irrespective of manometric findings: sham (no sphincterotomy), biliary sphincterotomy, and dual (biliary and pancreatic). Thirty-eight subjects had both biliary and pancreatic manometries performed twice, at baseline and at repeat endoscopic retrograde cholangiopancreatography after 1-11 months. Sham arm was examined to assess the reproducibility of manometry, and the treatment arms to assess whether the sphincterotomies were complete (elevated pressures were normalized). RESULTS: Biliary and pancreatic measurements were reproduced in 7/14 (50%) untreated subjects. All 12 patients with initially elevated biliary pressures in biliary and dual sphincterotomy groups normalized after biliary sphincterotomy. However, 2 of 8 subjects with elevated pancreatic pressures in the dual sphincterotomy group remained abnormal after pancreatic sphincterotomy. Paradoxically, normal biliary pressures became abnormal in 1 of 15 subjects after biliary sphincterotomy, and normal pancreatic pressures became abnormal in 5 of 15 patients after biliary sphincterotomy, and in 1 of 9 after pancreatic sphincterotomy. CONCLUSIONS: Our data suggest that SOM measurements are poorly reproducible, and question whether we could adequately perform pancreatic sphincterotomy.

Function of Oddi's sphincter with normal pancreatobiliary confluence and pancreatobiliary reflux / 中华消化内镜杂志

Objective To explore the impact of basal sphincter of Oddi (SO) pressure on pancreatobiliary reflux (PBR).Methods A total of 120 consecutive patients who received therapeutic ERCP for biliary tract diseases with or without the history of EST were enrolled,and were assigned to normal basal SO pressure group (n =23),elevated basal pressure group (n =55) and EST group (n =24).Basal SO pressure,bile amylase (BA) and bacteria culture findings were compared between the three groups.Results There were no differences in positive rate of bacteria culture,SO pressure increase and BA between the normal basal SO pressure group and elevated basal pressure group.In the latter group,negative correlation was observed between SO pressure and BA.The BA value [median(quartile range)] in patients with common bile duct ≥ 15 mm [4270 (12 337)U/L] was significantly higher than that in patients with common bile duct ＜ 15 mm [279.5 (1370) U/L].Furthermore,significant difference in both the proportion of elevated BA patients (83.3％ vs.59.0％) (P ＜0.05) and the positive rate of bacteria culture (75.0％ vs.33.3％) was seen between the intact papilla patients in the former two groups and those in EST group (P ＜ 0.05).Conclusion There was no direct correlation between the elevated basal SO pressure and PBR,but marked increase in diameter of common bile duct can lead to a rise in BA.Moreover,although EST can bring about PBR and bile bacterial infection,it may facilitate the outflow of the refluent pancreatic juice by relieving cholestasis.

Effect of Transdermal Fentanyl Patches on the Motility of the Sphincter of Oddi

BACKGROUND/AIMS: Pain is one of the most troublesome symptoms of pancreatitis. Transdermal fentanyl patches (TFPs) are long-acting analgesics with a reduced risk of dependency. This prospective study evaluated the effect of TFPs on sphincter of Oddi (SO) motility for the management of pain in pancreatitis. METHODS: SO manometry (SOM) was performed using triple-lumen catheters anterogradely inserted through the percutaneous transhepatic route during cholangioscopy in 16 patients. The basal pressure, amplitude, and frequency of the SO were assessed before and after applying a TFP at 24 hour at doses of 25 and 12.5microgram/hr, respectively. RESULTS: Two of 16 patients receiving a 25microgram/hr. TFP were excluded because of adverse side effects (headache and/or nausea). The mean basal pressure, amplitude, and frequency of SOM did not change significantly in the 25microgram/hr TFP group (n=4 patients). Parameters of SO function also did not significantly change in the 12.5microgram/hr TFP group (n=11 patients). CONCLUSIONS: TFPs below a dose of 25microgram/hr may not affect the motility of the SO. Administration of TFPs at lower dosages seems to be a safe analgesic treatment for the pain control of patients with pancreatitis without affecting the function of the SO.