SPHINCTER STENOSIS AND GALLSTONE MIGRATION THROUGH THE BILIARY-TRACT

We have investigated whether stenosis or insufficiency at the duodenal papilla results from the passage of a gallstone through the biliary t ract. In three groups of patients after cholecystectomy we studied mea l-stimulated pancreatic enzyme activity in T-drain bile from the commo n bileduct. Group A had gallbladder stones only; group B had gallbladd er stones and bileduct stones; and group C had an episode of acute gal lstone-induced pancreatitis, which was taken as direct evidence for ga llstone migration into the duodenum. Reflux of pancreatic juice into t he common bileduct was absent in group A, was occasionally found in gr oup B, and was strikingly increased in group C. We conclude that passa ge of a gallstone through the biliary tract causes functional stenosis of the sphincter of Oddi and allows for a common channel between the pancreatic duct and the common bileduct. It does not cause sphincter i nsufficiency as previously assumed.