Influence of cholangiography on biliary sphincter of Oddi manometric parameters

Abstract

Background: When sphincter of Oddi manometry (SOM) and endoscopic retrograde cholangiopancreatography are performed at the same session, SOM is usually performed immediately before ductography because of concern about the accuracy of the manometric recording after contrast medium injection. However, it would be preferable to inject contrast medium first to identify other causes for a patient's symptoms, allowing selective use of SOM. The aim of this study was to evaluate the effect of cholangiography on sphincter of Oddi (SO) basal pressure. Methods: Twenty-five patients with suspected SO dysfunction were prospectively studied. Conventional station pull-through manometry of the biliary part of the sphincter was performed before and after cholangiography. The intraductal pressure and basal sphincter pressure were evaluated. Results: The mean intraductal pressure was 8 ± 5.5 mm Hg before and 13.3 ± 6.8 mm Hg after contrast medium injection (p < 0.01). However, the basal sphincter pressure was not significantly altered (52.9 ± 42.1 mm Hg vs. 55.1 ± 38.1 mm Hg, p = 0.52). Concordance (normal vs. abnormal) between the basal sphincter pressure before and after ductography was seen in 24 of 25 patients (96%). Conclusions: Intraductal installation of contrast medium immediately before SOM infrequently alters SO basal pressure in a clinically significant manner. We therefore believe that this sequence can be utilized in clinical practice. (Gastrointest Endosc 2000;52:624-9.)