DOES ULTRASONOGRAPHY ALLOW PREDICTION OF BILIARY SPHINCTER OF ODDI DYSFUNCTION

A noninvasive test to prove sphincter of Oddi dysfunction is desired, because endoscopic manometry is technically demanding and not without risks. Methods: 40 consecutive patients (n = 20 patients with, and n = 20 patients without enzymatic cholestasis) with suspected SOD were in vestigated both by ultrasonography (US; 3.5 MHz) and by endoscopic man ometry. SOD was suspected at US if the extrahepatic bile duct diameter was greater than or equal to 9 mm and a further increase (at least > 0.5 mm) was observed after intravenous ceruletide (0.3 mu g/kg b. Tv.) . SOD was verified manometrically by a sphincter of Oddi basal pressur e greater than or equal to 40 mmHg. Endoscopic sphincterotomy was perf ormed if SOD was diagnosed by manometry. Thereafter, all patients were enrolled in a prospective follow-up (median: one year). Results: At U S SOD was suspected in eleven of 20 patients with cholestasis. SOD was confirmed manometrically in all of them but also in two further patie nts (13 of 20 patients with proven SOD). After EST twelve of 13 patien ts remained free from biliary symptoms. In the 20 patients without cho lestasis SOD was suspected at US in five patients only. However, endos copic manometry revealed SOD in eleven of 20 patients and proved sonog raphically presumed SOD in only three of five patients. After EST only three of eleven patients remained asymptomatic during follow-up (p < 0.05 vs. patients with cholestasis). Clinically important side effects were not observed after ceruletide administration, whereas postmanome try pancreatitis was observed in three of 40 patients. Conclusion: In patients with recurrent symptoms after cholecystectomy and enzymatic c holestasis SOD was reliably diagnosed by ultrasonography (sensitivity: 85%, specifity: 100%), and this finding may guide endoscopic sphincte rotomy.