ENDOSCOPIC BILIARY MANOMETRY IN CHOLECYSTECTOMIZED PATIENTS WITH AND WITHOUT CHOLEDOCHOLITHIASIS

BACKGROUND/AIMS: Direct study of the function of the sphincter of Oddi became possible recently with the advent of endoscopic manometry. A d ysfunction of the bilio-pancreatic sphincter apparatus has been implic ated in some bilio-pancreatic disorders. The purpose of this study was to examine the relation between dysfunction of the sphincter of Oddi and the formation of common bile duct stones. METHODOLOGY: Endoscopic biliary manometry was performed on 45 cholecystectomized patients. End oscopic retrograde cholangiography showed choledocholithiasis in 26 pa tients while 19 patients were free of common bile duct stones. Nine he althy subjects served as controls. RESULTS: Manometric investigation s howed a significant increase in the percentage of retrograde phasic co ntractions of the sphincter of Oddi (SO) in patients with choledocholi thiasis compared to the control group (p<0.05). Also, a significantly higher frequency of SO phasic contractions was found in the group of p atients with choledocholithiasis when compared to the cholecystectomiz ed group without common bile duct stones (p<0.05), but there was no di fference when compared with the control group. Markedly increased SO b asal pressure was found in 5 patients with choledocholithiasis as well as in one cholecystectomized patient without choledocholithiasis (gre ater than x+3SD). However, the SO basal pressure, phasic SO pressure, amplitude and duration of the phasic contractions as well as the chole dochal pressure did not differ significantly between the groups. CONCL USIONS: This study demonstrates manometric abnormalities in the SO of patients with choledocholithiasis which suggests that SO dysfunction a nd pathophysiological mechanisms are related to the formation of commo n bile duct stones.