BILIARY DYSKINESIA - ROLE OF THE SPHINCTER OF ODDI, GALLBLADDER AND CHOLECYSTOKININ

The availability of objective and quantitative diagnostic tests in rec ent years has allowed more precise documentation of biliary dyskinesia . Biliary dyskinesia consists of two disease entities situated at two different anatomical locations: sphincter of Oddi spasm, at the distal end of the common duct, and cystic duct syndrome, in the gallbladder. Both conditions are characterized by a paradoxical response in which the sphincter of Oddi and the cystic duct contract (and impede bile fl ow) instead of undergoing the normal dilatation, when the physiologica l dose of cholecystokinin is infused. Quantitative cholescintigraphy c an clearly differentiate one disease entity from the other. The therap ies of choice are sphincterotomy, sphincteroplasty or antispasmodics f or sphincter of Oddi spasm and cholecystectomy for cystic duct syndrom e. After quantitative cholescintigraphy, the final impression should i dentify the disease entity by name to assist the referring physician i n making an appropriate therapeutic decision; a mere statement that a test is consistent with biliary dyskinesia is no longer sufficient.