ENDOSCOPIC MANOMETRY OF THE SPHINCTER OF ODDI IN SPHINCTEROTOMIZED PATIENTS

Background/Aims: Endoscopic sphincterotomy (ES) of the sphincter of Od di (SO) has been accepted as an effective method in extraction of comm on bile duct stones in postcholecystectomy patients. The purpose of th is study was to examine the completeness of the performed ES and obser ve the post sphincterotomy pancreatic duct sphincter (PDS) activity us ing endoscopic manometry. Materials and Methods: Activity of the sphin cter of Oddi was examined in 15 sphincterotomized patients using endos copic manometry one to 2.5 years after endoscopic sphincterotomy for c holedocholithiasis. Results: In eight patients absence of choledochodu odenal gradient, baseline pressure and the sphincter of Oddi phasic ac tivity up to 2,5 years after endoscopic sphincterotomy indicated a com plete sphincterotomy. In seven patients with incomplete endoscopic sph incterotomy, manometry exhibited either a lower choledochoduodenal gra dient and baseline pressure without phasic activity of the sphincter o f Oddi (three patients), a sphincter of Oddi activity without choledoc hoduodenal gradient (one patient), or a complete restitution of the sp hincter of Oddi activity 1 to 2 years after endoscopic sphincterotomy (three patients). In five patients, with complete endoscopic sphincter otomy, measurements of pancreatic sphincter activity showed lower valu es of the pancreatic ductal pressure and baseline pressure, while the pancreatic sphincter phasic activity was equal to that found in the co ntrol group. Conclusions: Endoscopic manometry is method which enables us to test the completeness of endoscopic sphincterotomy and to follo w the restitution of the phasic contractile function of the sphincter. Manometric findings reveal pancreatic sphincter in most patients as a separate sphincteric entity, the function of which is reduced but not eliminated by a complete endoscopic sphincterotomy.