Tl. Abell et al., BILIARY, PANCREATIC, AND SPHINCTER OF ODDI ELECTRICAL AND MECHANICAL SIGNALS RECORDED DURING ERCP, Digestive diseases and sciences, 43(3), 1998, pp. 540-546
Measurements of biliary tract motility have focused on radiologic and
pressure measurements to quantify biliary motility rather than measure
ments of electrical activity of the biliary tract. We previously repor
ted the recording of biliary electrical signals during ERCP and now re
port on the continued development and validation of a system to measur
e biliary tract electrical activity as well as biliary mechanical acti
vity. In 26 patients presenting with a variety of clinical indications
, we recorded measurements of electrical activity from the common bile
duct sphincter (16 patients), pancreatic duct sphincter (eight patien
ts), and/or sphincter of Oddi (eight patients). Electrical recordings
were performed with a specially modified ERCP catheter, using two circ
ular electrodes as well as a custom catheter that measured both electr
ical and mechanical activity. Electrical activity of the biliary tract
was successfully recorded in 25 of 26 patients (96%), including the c
ommon bile duct sphincter (16 patients, 62%), pancreatic duct sphincte
r (eight patients, 31%) and sphincter of Oddi (eight patients, 31%). A
long with the electrical recordings, common bile duct sphincter mechan
ical activity was recorded in 12 patients (67%), pancreatic duct sphin
cter mechanical activity in six patients (33%), and sphincter of Oddi
mechanical activity in six patients (33%). Frequency analysis of elect
rical signals revealed a mean frequency (cycles/min) of 4.7 +/- 0.5 in
the common bile duct sphincter, 4.1 +/- 0.6 in the pancreatic duct sp
hincter, and 4.9 +/- 0.7 in the sphincter of Oadi. Phasic mechanical f
requency in cycles per minute was recorded at a frequency of 4.8 +/- 0
.5 in common bile duct sphincter, 4.0 +/- 0.6 in pancreatic duct sphin
cter, and 5.3 +/- 0.9 in sphincter of Oddi. Tonic pressure (averaged 1
2.1 +/- 1.5 mm Hg) in common bile duct sphincter, 12.4 +/- 1.4 mm Hg i
n pancreatic duct sphincter, and 15.0 +/- 5.1 mm Hg in sphincter of Od
di. Analysis of wave form propagations (noted as percentage antegrade,
retrograde, or indeterminant) revealed 50% antegrade, 23% retrograde,
and 27% indeterminant). One patient was recorded on two occasions via
ERCP; the same patient had an Intraoperative recording; All three rec
ordings showed similarities. We conclude that measurements of biliary,
pancreatic, and sphincter of Oddi electrical and mechanical activity
are feasible and can be done as part of ERCP. There was good correlati
on between biliary tract electrical and mechanical events and differen
t wave form characteristics were noted for different parts of the bili
ary ti ee. Further studies are warranted to evaluate the potential use
fulness of measurement of biliary tract electrical activity, and to co
nfirm its correlation with mechanical events in the pancreato-biliary
tree.