Jm. Marks et al., A comparison of common bile duct pressures after botulinum toxin injectioninto the sphincter of Oddi versus biliary stenting in a canine model, AM J SURG, 181(1), 2001, pp. 60-64
Background: Botulinum toxin A (Botox) functionally paralyzes the sphincter
of Oddi in both animals and humans, resulting in reduced pressures. No stud
y, however, has specifically addressed common bile duct (CBD) pressures aft
er Botox injection into the sphincter of Oddi with regard to treating bilia
ry leaks and fistulae. The goals of this present study are to compare, vers
us biliary stenting, the change in CBD pressures after Botox injection into
the sphincter of Oddi, as well as to evaluate the timing of onset and dura
tion of these effects on sphincteric relaxation.
Methods: After midline laparotomy in 20 mongrel dogs, a pediatric umbilical
catheter was inserted into the CBD via a small chloecystotomy and attached
to a water-perfused pressure transducer, After baseline CD pressure readin
gs, a lateral duodenotomy was performed. A total of 100 units of Borer was
injected with an endoscopic sclerotherapy needle into all four quadrants of
the ampulla. The dogs were randomly divided into four groups to undergo re
peat laparotomy at either postoperative day 1 (group I), postoperative day
3 (group II), postoperative day 7 (group III), or postoperative day 14 (gro
up IV). At the time of second laparotomy, a pressure-sensing catheter was r
einserted into the CBD and pressures recorded. Each dog then underwent tran
spapillary biliary stenting with a 7 Fr. x 5 cm Cotton-Leung biliary stent
and CBD pressures were again recorded.
Results: CBD pressures were significantly lower as compared with baseline f
or all groups after Botox injection and after biliary stenting (P <0.001) I
n addition, no significant differences in the degree of CBD pressure reduct
ion were identified between groups I through IV after Botox injection. The
measured decrease in CBD pressure from baseline after Botox injection as co
mpared with biliary stenting was significantly different for groups I and I
I (P <0.05) but not for groups III and IV.
Conclusion: Botox injection into the sphincter of Oddi results in significa
nt CBD pressure reduction within 14 hours and continues fur 14 days. Also,
after postoperative day 3, there is no significant difference in the reduct
ion of CBD pressure from baseline between Botox injection and biliary stent
ing. Based on these findings, Botox injection into the sphincter of Oddi ma
y be a beneficial alternative to biliary stenting for the treatment of bili
ary leaks and fistulae. (C) 2001 Excerpta Medica, Inc. All rights reserved.