EVALUATION OF RESULTS OF THE PROSTIGMINE-MORPHINE TEST WITH QUANTITATIVE HEPATOBILIARY SCINTIGRAPHY - A NEW METHOD FOR THE DIAGNOSIS OF SPHINCTER-OF-ODDI DYSKINESIA

Attempts have long been made to use the prostigmine-morphine provocati on test for the selection of postcholecystectomy patients suffering fr om sphincter of Oddi (SO) dyskinesia. Since the whole procedure is bas ed upon the evaluation of subjective complaints, this test has frequen tly been criticized. To improve the diagnostic value of this method, w e have visualized SO spasms during prostigmine-morphine provocation by means of quantitative hepatobiliary scintigraphy (QHBS). Twenty-two c holecystectomized patients with typical postprandial biliary pain were included in this study. In the first series of studies, QHBS with tec hnetium-99m 2,6-diethylphenylcarbamoylmethyl-diacetic acid was perform ed in each patient 2 days before pros tigmine-morphine provocation. Th e time to peak activity (T-max) and the half-time of excretion (T-1/2) over the liver parenchyma (LP), hepatic hilum (I-III) and common bile duct (CBD), and the duodenum appearance time (DAT), were determined a nd served as control values. In the second series of experiments, sphi ncter spasms were evoked by prostigmine-morphine administration and vi sualized by means of QHBS. The same parameters were evaluated and seru m levels of aspartate aminotransferase (AST) were determined simultane ously at regular intervals. In 12 patients who responded to prostigmin e-morphine provocation with typical biliary pain and a significant AST elevation (Nardi positive group) the hepatobiliary scintigram demonst rated a marked biliary obstruction. T-max and T-1/2 over the LP, I-III and CBD were significantly increased, while DAT was significantly lon ger relative to the corresponding data obtained without provocation, F our of the remaining ten patients indicated atypical abdominal pain du ring prostigmine-morphine provocation, but the AST level remained unch anged in all ten (Nardi negative group), In this group, QHBS revealed a slower, but free transpapillary flow of the tracer: although T-1/2 o ver the LP, HH and CBD appeared to be significantly higher than withou t provocation, T-max did not change and an obstructive pattern was not detected on the hepatobiliary scintigram. When QHBS parameters determ ined during prostigmine-morphine provocation were compared for the Nar di positive and Nardi negative groups, with the exception of T-max ove r the LP they were significantly different. QHBS combined with the pro stigmine-morphine provocation test proved to be a useful non-invasive method for the detection of pathological sphincter spasms in patients with SO dyskinesia. Application of this method is therefore strongly r ecommended in the diagnosis of SO dyskinesia.