Acute biliary pancreatitis: sphincter of Oddi and choledochal pressure.

Twenty four patients with biliary pancreatitis were divided into three groups: A (18 subjects underwent surgery on the biliary tract seven days after admission to hospital when acute signs disappeared); B (3 cases were operated two months later), and C (3 patients underwent emergency surgery for acute cholescistitis with simultaneous acute pancreatitis). A cholecistectomy-choledochostomy through a Kehr tube was performed in all patients. Pressure in the main biliary duct (MBD) was measured. Only group A was significant (18 cases). As a control, another group, group D was considered (52 biliary cholecysto-choledochal lithiasis patients without pancreatitis and without transduodenal sphincterotomy). Group A: 1) The mean pressure in MBD on the fourth postoperative day (11 days after onset of pancreatitis) was low (p < 0.0001) in relation to that of group D with Oddi's sphincter (SO) normal; 2) in group A, no significant differences (p-NS) were found in relation to positions: during fasting, 4.4 +/- 4 cm H2O in the upright position, and 5.3 +/- 2 when lying (in group D, 9.9 +/- 4.1 cm H2O upright, and 7.76 +/- 3.6 lying with p = 0.0001), and 3) a slow improvement of pressure was observed and, on the 25th day after operation, it was nearly normal (9 cm H2O upright and 7 cm lying with p < 0.001). Group B: biliary surgery at 2 months; mean pressure in MBD meartly normal. Group C: 1) 4 days after emergency surgery, the pressure in MBF (15 cm H2O upright and 11.7 lying) was higher than in subjects with normal SO, probably due to compression of the distal part of MBD by the inflamed pancreas, and 2) from the 11th day the pressure followed the same evolution as that of group A. In conclusion, in patients with acute biliary pancreatitis, operated on the biliary tract when acute signs disappeared, MBD pressure is low (p < 0.0001) in reference to normal on the fourth post-operatory day (11 days after onset of pancreatitis) and no significant differences were found in relation to positions (upright and lying). The pressure changes are transient (4-5 weeks) and most probably due to the lesions and malfunction of the SO related to pancreatitis.

[Cholelithiasis. Post-choledochostomy intraductal pressure (without and with sphinctero-infundibulostomy]. / Colelitiasis. Presiones intraductales poscoledocotomía (sin y con esfinteroinfundibulotomía).

In 72 patients operated on for lithiasis of the main biliary duct (MBD), the intraductal pressure was measured through the choledochostomy T-tube. This measure was done, both in upright and lying positions, fasting and after lunch. Two groups were considered: A (of 52 cases) and B (of 20 cases). In both groups a choledochotomy was performed, and only in group B a long, although partial, sphincterotomy was also done. Three patients in group B had the upper part of the sphincter of Oddi (SO) dilated by big stones. 1) When groups A and B were compared, no significant differences of pressures in MBD was found. 2) Highly significant differences (p = 0.0001) were always found when paired data related to positions were compared: in the upright position pressures in MBD were higher than on the lying position. Group A, during fasting (9.90 +/- 4.1 cm H2O, in upon position, and 7.76 +/- 3.6 when lying) and group B, also at fasting (8.95 +/- 3.0 in the upright position and 6.57 +/- 3.0, when lying). The three patients included in group B with big stones impacted in the upper part of SO, showed low pressures in MBD, specially one (2 and 1 cm H2O, upright lying positions), but the group is too small have statistical significance. We conclude that the long but partial sphincterotomy does not modify significantly the pressures in MBD whether upright or lying, and when paired data related to positions were compared, upright pressures were always higher than on the lying position (p = 0.0001).

[Somatostatin and choleresis in human beings during the digestive phase]. / Somatostatina y coleresis en el ser humano durante la fase digestiva.

The effect of somatostatin on human choleresis has been poorly studied. Nearly all present knowledge comes from animal research (dog). In the human being, the effect is known in fasted patients. But no data are available of its action during digestion. In the present study, before removing the choledochostomy T-tube from 73 patients operated on for biliary disease, the bile output (40% of the total choleresis) was measured for 4 hours, at 30 min intervals: during fasting, lunch and after lunch: 1) at fasting (A) 10.5 +/- 2.2 cc; at lunch (B) 18.6 +/- 5.4 cc, and after lunch (C) 16.8 +/- 4.5 cc. These differences were highly significant: A vs B p < 0.0001, and A vs C p < 0.0001. In a second part, 10 of these patients received subcutaneously 0.1 mg of SMS 201-995 (a somatostatin's analogue) 30 min before lunch. In all patients the bile output was significantly reduced: 1) prandial phase (D) 9.6 +/- 2.6 cc, and 2) post-prandial phase (E) 5.1 +/- 2.2 cc. Flow in E was significantly reduced when compared to A. Action of 0.1 mg SMS lasted about 120 min. We conclude that SMS decreases prandial and postprandial choleresis in humans.