Video manometry of the sphincter of Oddi: A new aid for interpreting manometric tracings and excluding manometric artefacts

Background and Study Aims: Endoscopic sphincter of Oddi manometry (ESOM) al lows direct assessment of motor function in the sphincter of Oddi. However, variations in examination conditions and duodenal motility may have a crit ical effect on the results of ESOM. The aim of the present study was to dev elop a new method sphincter of Oddi video manometry - based on simultaneous ESOM and real-time endoscopic image analysis, and to investigate the usefu lness of video manometry for detecting manometric artefacts during ESOM. Patients and Methods: Seven consecutive patients who had undergone cholecys tectomy and were referred with a suspicion of sphincter of Oddi dysfunction were investigated, Sphincter of Oddi pressure and endoscopic images (20 fr ames/s) were recorded simultaneously on a Synectics PC Polygraf computer sy stem with a time-correlated basis, and then compared. Results: On ESOM, 69 sphincter of Oddi phasic contractions were identified, with an average amplitude of 153.9 +/- 85.0 mmHg and a duration of 7.9 +/- 1.2 seconds. Visual analysis of the real-time endoscopic images, replayed in cine loop by the computer, revealed 236 separate duodenal contractions, with an average frequency of 3.5 +/- 2.4/min (range: 1-12/min). On the ESOM tracing, 78% of the duodenal contractions had a corresponding pressure wav e with an average duration of 2.8 +/- 0.4 seconds and an amplitude of 71.9 +/- 16.7 mmHg. Other artefacts on the ESOM tracings, such as catheter movem ents, pseudocontractions, hyperventilation, or retching, were also easily r ecognized using simultaneous ESOM and real-time endoscopic image analysis. Conclusions: Video manometry of the sphincter of Oddi is a promising new me thod for improving the analysis and documentation of ESOM tracings. It has several advantages over the conventional technique, allowing visual detecti on of duodenal activity and enabling enhanced recognition of other manometr ic artefacts.