Common Bile Duct Pressure Research Articles

Bacteriobilia frequency in patients afflicted by biliary obstruction at a tertiary care center

Background: Bile typically remains sterile within individuals possessing a normal biliary tract, but bacterial colonization arises with biliary obstruction. Infections often stem from ascending duodenal infection or bacterial translocation from the portal vein. Elevated common bile duct pressure due to obstruction, combined with infected bile, can lead to bacterial backflow into lymphatics, fostering cholangitis. In this study, 30 sequential bile samples were examined, scrutinizing the occurrence of bacteriobilia and comparing its incidence between benign and malignant etiologies. Aims and Objectives: Bacteriobilia typically manifests without symptoms. This study aimed to assess the prevalence of bacteriobilia in patients with obstructive jaundice undergoing endoscopic retrograde cholangiopancreatography (ERCP) at our institution, investigating associated risk factors. Furthermore, the study aimed to elucidate the microbiological profile of bile in obstructed biliary systems, make a comparative analysis of bacteriobilia frequency between benign and malignant obstructions, and delve into the drug sensitivity patterns of bacteria cultured from bile at our center. Materials and Methods: In a prospective, observational, and diagnostic study conducted at the Department of Digestive Health and Diseases, Government Peripheral Hospital, Anna Nagar, Chennai, from September 2011 to February 2012, with ethical committee approval and informed consent from all participants, we investigated 30 consecutive patients who underwent ERCP for biliary obstruction. The study cohort comprised 13 males and 17 females. Following successful biliary cannulation, bile samples were collected and subjected to microbiological analysis. Results revealed positive bile cultures in 16 patients, with 10 exhibiting benign etiology and 6 malignant. Gram-negative organisms, predominantly Klebsiella, were identified, displaying favorable susceptibility to cephalosporins while demonstrating resistance to ciprofloxacin. Results: Bile cultures yielded positive results in 16 patients, with 10 cases attributed to benign etiology and 6 to malignant etiology. The cultured organisms were predominantly Gram-negative, with Klebsiella exhibiting significant growth. Notably, these organisms exhibited favorable susceptibility to cephalosporins while displaying resistance to ciprofloxacin. Conclusion: Bile culture serves as a valuable tool for prompt diagnosis and pre-emptive management of complications. Gram-negative bacilli infections prevail within obstructed biliary systems. This study underscores the pivotal role of routine bile sampling during ERCP in obstructed biliary systems, offering predictive insights to avert complications like cholangitis.

Common bile duct pressure after open intraoperative instrumentation in patients with uncomplicated choledocholithiasis.

Common bile duct pressure (CBDP) after surgical exploration has not been fully detailed. The objective was to describe the changes of CBDP after open surgical exploration in patients with choledocholithiasis, considering clinical scenarios in remote locations. A before-after study was designed. Patients with choledocholithiasis who required an open cholecystectomy with exploration of bile ducts were included in the study. Open cholecystectomy was performed and perioperative T-tube CBDP was registered immediately after the procedure and weekly thereafter, with a 6 week follow-up. Control T-tube cholangiogram was performed at week 6 to exclude residual stones. Data were analyzed with T test for paired samples. Thirteen patients were included (age range, 17-69 years; 38.69 ± 17.97). Mean CBDP (cm H2O) registered were as follows: Initial = 19.5, week 1 = 16.2, week 2 = 14.3, week 3 = 13.0, week 4 = 12.1, week 5 = 11.1, and week 6 = 9.7. There were significant differences shown when comparing week 2 (p = 0.05), week 3 (p = 0.036), week 4 (p = 0.023), week 5 (p = 0.010), and week 6 (p = 0.004) with the initial value. CBDP decreases between 2nd and 3rd post-operative weeks. The use of choledochomanometry is useful in clinical scenarios with no access to imaging or interventionism facilities as in remote populations or rural locations.

Analysis of the Relationship Between Periampullary Diverticulum and Recurrent Bile Duct Stones After Endoscopy on Magnetic Resonance Imaging of Magnetic Nanoparticles

The objective of this work was to investigate the effect of magnetic resonance cholangiopancreatography (MRCP) based on super-paramagnetic iron oxide nanoparticles (SPIONs) on the recurrence diagnosis of periampullary diverticulum (PAD) and bile duct stone (BDS), so as to provide a scientific research basis for the recidivation factors of bile duct stones in clinic. Patients with PAD diagnosed in hospital from July 2019 to March 2021 (who had undergone endoscopic gallstone surgery) were selected for study in this work. They were rolled into two groups, the parapapillary group (123 cases) and the cholangiopancreatic duct directly opening in the diverticulum group (97 cases), according to the clinical classification. Then, 100 patients without PAD who had undergone bile duct node therapy were selected as the control group. The recidivation of BDS, serological index, and biliary pressure index before and after treatment were compared. The relationship between PAD and recidivation of bile duct stones was analyzed. The results showed that the average particle size, hydration kinetic particle size, effective time, and duration of polyethylene glycol (PEG)/polyethyleneimine (PEI)/poly aspartic acid-super-paramagnetic iron oxide nanoparticles(PASP-SPIONs) were better than PEG/PEI-SPIONs and SPIONs. The recidivation rate of BDS in Groups R and X was remarkably higher than the rate in control group (P < 0.05). Before treatment, common bile duct pressure in the control group was lower obviously than that in Groups R and X (P < 0.05). After treatment, the indexes including total bilirubin, direct bilirubin, and alkaline phosphatase in control group were lower than those in Groups R and X (P < 0.05). The incidence of complications in Groups R and X was much higher than in contrast to the control group (P < 0.05). Therefore, PEG/PEI/PASP-SPIONs had good contrast effect and could be used as magnetic resonance imaging contrast agent. Complications such as common bile duct pressure and infection were increased by PAD, which may be the main factor for the recidivation of BDS.

Common bile duct pressure in patients with and without cholelithiasis: A case-control study.

The reflux of pancreatic enzymes into the bile duct and the gallbladder is an abnormal phenomenon that plays a role in lithogenesis and carcinogenesis. Because the pressure of the common bile duct depends on the pressures of the sphincter of Oddi, its dysfunction would be reflected in an increase in the pressure of the common bile duct in patients with cholelithiasis. The objective of this study was to measure the pressures of the common bile duct in patients with and without cholelithiasis and to relate them to the presence of pancreatobiliary reflux. A prospective case-control study was designed. The study universe was constituted by all patients undergoing total gastrectomy for gastric cancer stages I and II over 30months. The primary outcome measure was to establish differences between common bile duct pressures in patients with and without cholelithiasis. Common bile duct pressures in patients with gallstones showed a significant elevation (16.9mmHg) compared to patients without gallstones (3.3mm Hg) (p<0.0001). These pressures correlated with the levels of amylase and lipase in gallbladder bile; higher levels were found in patients with gallstones compared to patients without gallstones (P<0.0001). Common bile duct pressure in patients with cholelithiasis was significantly higher compared to patients without cholelithiasis leading to pancreatobiliary reflux.

Endoscopic endoclip papilloplasty preserves sphincter of oddi function.

Endoscopic sphincterotomy (EST) can destroy sphincter of Oddi (SO) structure and function. The purpose of this study was to assess the feasibility of endoscopic endoclip papilloplasty (EEPP) in restoring SO function after EST. Seven 26-week-old domestic pigs were divided into control and EEPP groups. Necropsy and haematoxylin-eosin staining plus anti-α-smooth muscle actin (α-SMA) staining of papilla and sphincter of Oddi manometry (SOM) were conducted in animals at three independent time points. EST and EEPP were safely performed in all 7 pigs without serious adverse events. For primary outcome, compared to the controls, EEPP generated smaller dilation and less inflammation. Fibrous repair of the papilla was observed at 24weeks after EEPP. For secondary outcome, in the control group, SO basal pressure (17.25±18.14 to 5.50±0.71mmHg), SO contraction amplitude (46.00±19.20 to 34.50±48.79mmHg), peak (4.50±4.04 to 1.50±2.12) and frequency (3.05±3.29 to 1.41±2.19/min) were reduced after EST. Further reductions to almost 0 of these SOM parameters were observed 3weeks later, including common bile duct pressure and SO contraction period. In contrast, in the EEPP group, these manometric data were recovered to pre-EST levels, including CBD pressure (11.5±7.31 vs 11±2.16mmHg), SO pressure (17.50±17.75 vs 18.20±21.39mmHg) and SO contraction amplitude (53.67±21.54 vs 60.00±36.08mmHg). However, no significant differences were observed between control and EEPP groups by Student t test. In this porcine study, EEPP accelerated and improved papillary healing after EST, further preserved SO function.

Su1548 THE IMPACT OF INCREASED BILE DUCT PRESSURE RELATED TO PAPILLARY STENOSIS AND THE ROLE OF VISCERAL HYPERSENSITIVITY IN PATIENTS WITH REFRACTORY RIGHT UPPER QUADRANT (RUQ) PAIN POST CHOLECYSTECTOMY

Functional abdominal pain is commonly related to visceral hypersensitivity (VH) and recent studies have shown success in management of such patients with Amitriptyline. A subgroup of patients with chronic RUQ pain post cholecystectomy routinely fail medical management and are referred for evaluation of Sphincter of Oddi (SOD) dysfunction/papillary stenosis. The association of RUQ pain, dilated common bile duct (CBD) and elevated liver function tests (LFT’s) is strongly suggestive of papillary stenosis as it has been shown to benefit the most from biliary sphincterotomy. The aim of this study was to determine the risks/benefits of endoscopic sphincterotomy in this subgroup of patients with refractory RUQ pain and to delineate the role of Amitriptyline in the presence of VH. Retrospective review, from 2015 to 2018, of treatment outcomes of patients with post cholecystectomy RUQ abdominal pain refractory to medical treatment. All patients had treatment with biliary sphincterotomy by single expert endoscopist. Patients with pancreaticobiliary malignancies or prior history of pancreatitis were excluded from the study. Data including patient demographics, clinical symptoms (pre and post ERCP), elevated LFT’s, CBD size, use of narcotics, prior history of IBS, post procedure complications (pancreatitis, bleeding) and prophylactic pancreatic duct stent placement was collected. Patients with no or partial improvement were treated with low dose (10-25 mg) Amitriptyline daily for presumed VH. 75 patients were included in the study. Mean age was 52 years with 68 (93%) females. 30 (40%) of patients had a dilated CBD. 14 (19%) had elevated LFT’s. 57 (76%) had constant RUQ pain. A total of 67 (89%) patients reported improvement in symptoms post sphincterotomy (49 (65%) patients achieved partial resolution and 18 (24%) complete resolution). A total of 13 (17%) patients did not achieve symptoms resolution and were treated with Amitriptyline. 12 out of 13 patients (92%) experienced a favorable symptom response to Amitriptyline. 6 (8%) patients had minor complications (pain and mild pancreatitis) and 1 patient (1%) had a major complication (necrotizing pancreatitis). A prophylactic pancreatic duct stent was placed in 38 (50.7%) of patients. 44 (58.6%) patients were discharge home post procedure. Biliary sphincterotomy provided by expert endoscopist is a very effective and safe intervention for patients with refractory RUQ abdominal pain post cholecystectomy. Constant RUQ pain and failure to respond to medical management should raise the suspicion for papillary stenosis. Based on the response to sphincterotomy, we extrapolate that elevated CBD pressure is the cause of discomfort in these patients with visceral hypersensitivity. Therefore, low dose Amitriptyline should be used for patients with partial response to biliary sphincterotomy.Graph 1: One-sample z-test of symptom improvement in included patientsView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Common Bile Duct Pressures in Patients With and Without Cholelithiasis

Common Bile Duct Pressures in Patients With and Without Cholelithiasis

Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis

Common bile duct (CBD) stones are generally associated with greater elevations of alkaline phosphatase and gamma-glutamyl transpeptidase levels than aspartate aminotransferase and alanine aminotransferase levels. However, some patients with CBD stones show markedly increased aminotransferase levels, sometimes leading to the misdiagnosis of liver disease. Therefore, the aim of this study was to investigate the clinicopathologic features of patients with CBD stones and high aminotransferase levels.This prospective cohort study included 882 patients diagnosed with CBD stones using endoscopic retrograde cholangiopancreatography (ERCP). Among these patients, 38 (4.3%) exhibited aminotransferase levels above 400 IU/L without cholangitis (gallstone hepatitis [GSH] group), and 116 (13.2%) exhibited normal aminotransferase levels (control group). We compared groups in terms of clinical features, laboratory test results, radiologic images, and ERCP findings such as CBD diameter, CBD stone diameter and number, and periampullary diverticulum. Liver biopsy was performed for patients in the GSH group.GSH patients were younger and more likely to have gallbladder stones than control patients, implying a higher incidence of gallbladder stone migration. Also, GSH patients experienced more severe, short-lasting abdominal pain. ERCP showed narrower CBDs in GSH patients than in control patients. Histological analysis of liver tissue from GSH patients showed no abnormalities except for mild inflammation.Compared with control patients, GSH patients were younger and showed more severe, short-lasting abdominal pain, which could be due to a sudden increase of CBD pressure resulting from the migration of gallstones through narrower CBDs. These clinical features could be helpful not only for the differential diagnosis of liver disease but also for investigating the underlying mechanisms of liver damage in obstructive jaundice. Moreover, we propose a new definition of “gallstone hepatitis” based on the specific clinicopathologic characteristics observed in our patients.

Effects of carbon dioxide insufflation during direct cholangioscopy on biliary pressures and vital parameters: apilot study in porcine models.

Direct per-oral cholangioscopy allows endoscopic visualization of the biliary tract. Insufflation with carbon dioxide (CO2) is an alternative to saline solution irrigation during direct cholangioscopy. There are no data on maximal CO2 insufflation in direct cholangioscopy without causing biliary barotrauma or fatal gas embolism. We aimed to evaluate the safety of increasing CO2 insufflation in direct cholangioscopy without causing biliary barotrauma or fatal gas embolism. This was an invivo animal study. Four domestic pigs, under general endotracheal anesthesia, were used. The first animal was used to validate the feasibility of direct cholangioscopy and biliary pressure measurements, after which all animals underwent laparotomy, insertion of a pressure transducer in the cystic duct, and direct transpapillary placement of the cholangioscope. The common bile duct (CBD) and cystic duct were ligated to contain the instilled gas and exclusively expose the biliary tree. Insufflation of CO2 started at 200 mL/min and was continuously increased until there was evidence of bile duct rupture (as measured by a drop in intraductal pressures) or instability of vital signs (hypotension, bradycardia, bradypnea, O2 desaturation). Necropsy was performed on all animals to assess the liver and biliary system for evidence of barotrauma. CO2 was insufflated up to 8 L/min without causing bile duct rupture or instability in vital signs despite increasing CBD pressure with insufflation. There was significant correlation between CO2 flow with partial pressure of CO2 in arterial blood (PaCO2) (coefficient, 0.96-1.00; P< .01) and end tidal expired CO2 (EtCO2) (coefficient, 0.94-1.00; P< .01). However, the pulse rate, respiratory rate, arterial blood pressure, and O2 did not correlate with the amount of CO2 flow. There was no evidence of hepatic or biliary barotrauma on necropsy. This pilot experience in porcine models suggests that CO2 insufflation is safe for direct cholangioscopy and does not result in biliary barotrauma or vital signs instability.

Effects of sphincter of Oddi motility on the formation of cholesterol gallstones.

To investigate the mechanisms and effects of sphincter of Oddi (SO) motility on cholesterol gallbladder stone formation in guinea pigs. Thirty-four adult male Hartley guinea pigs were divided randomly into two groups, the control group (n = 10) and the cholesterol gallstone group (n = 24), which was sequentially divided into four subgroups with six guinea pigs each according to time of sacrifice. The guinea pigs in the cholesterol gallstone group were fed a cholesterol lithogenic diet and sacrificed after 3, 6, 9, and 12 wk. SO manometry and recording of myoelectric activity were obtained by a multifunctional physiograph at each stage. Cholecystokinin-A receptor (CCKAR) expression levels in SO smooth muscle were detected by quantitative real-time PCR (qRT-PCR) and serum vasoactive intestinal peptide (VIP), gastrin, and cholecystokinin octapeptide (CCK-8) were detected by enzyme-linked immunosorbent assay at each stage in the process of cholesterol gallstone formation. The gallstone formation rate was 0%, 0%, 16.7%, and 83.3% in the 3, 6, 9, and 12 wk groups, respectively. The frequency of myoelectric activity in the 9 wk group, the amplitude of myoelectric activity in the 9 and 12 wk groups, and the amplitude and the frequency of SO in the 9 wk group were all significantly decreased compared to the control group. The SO basal pressure and common bile duct pressure increased markedly in the 12 wk group, and the CCKAR expression levels increased in the 6 and 12 wk groups compared to the control group. Serum VIP was elevated significantly in the 9 and 12 wk groups and gastrin decreased significantly in the 3 and 9 wk groups. There was no difference in serum CCK-8 between the groups. A cholesterol gallstone-causing diet can induce SO dysfunction. The increasing tension of the SO along with its decreasing activity may play an important role in cholesterol gallstone formation. Expression changes of CCKAR in SO smooth muscle and serum VIP and CCK-8 may be important causes of SO dysfunction.

Establishment of a novel rat model of severe acute cholangitis.

This study aimed to establish a novel non-binding, reversible rat model of acute cholangitis of the severe type (ACST). Twenty-six rats were randomly divided into the sham-operated group (n=13) and the ACST group (n=13). All rats were intubated with a modified catheter through the external jugular vein. The ACST model was established by ligation of the distal bile duct, placing one end of a modified catheter in the common bile duct, and then injecting lipopolysaccharides from the other end of the catheter and sealing it. The common bile duct pressure was measured before and at 0, 24, 48, and 72 hr after the model was established; similarly, the levels of serum total bilirubin (TBIL), alanine aminotransferase (ALT), and tumor necrosis factor (TNF)-α were measured at 0, 12, 24, and 48 hr after the model was established. Pathological examination of liver tissues was carried out at 24 and 72 hr. The common bile duct pressure increased gradually after the operation. Serum levels of TBIL, ALT, and TNF-α in the ACST group progressively increased and were significantly higher than those in the sham-operated group, at each time point (P<0.05). Obvious pathological changes were observed in the liver tissue of rats in the ACST group. This model appears to reflect the early course of human ACST and thus, can be used in postoperative experimental studies of ACST.

Biliary manometry in patients with common bile duct stones and juxtapapilary duodenal diverticulum

Objective To explore the impact of juxtapapilary duodenal diverticulum on the formation of choledocholithiasis and biliary manometry after surgery. Methods The clinical data of 97 patients with common bile duct stones who successfully underwent ERCP and biliary manometry treatment from May 2011 to March 2014 were retrospectively analyzed. Ninty-seven common bile duct stone patients were divided to two groups, that is, 52 cases of juxta-papilary duodenal diverticulum (experimental group) and 45 cases without juxta-papilary duodenal diverticulum (control group). The biliary manometric results before and after EST of both groups were compared. Results The basal pressure of sphincter Oddi of the experimental group before EST[(84.8±26.1)mmHg]was higher than that of the control group before EST[(75.5±14.6)mmHg](P 0.05). The biliary manometry was performed in 81 patients after one month and it was found that the basal pressure of sphincter Oddi of experimental group was still higher than that of the control group[(34.8±17.1) mmHg VS (29.6±15.3)mmHg, P<0.05]. The biliary pressure of common bile of the experimental group was higher than that of the control group[(19.9±11.2)mmHg VS (17.1±13.1)mmHg, P<0.05]. Conclusion The existence of juxtapapilary duodenal diverticulum increases the pressure of common bile duct and Oddi sphincter and leads to CBD stones. Key words: Biliary manometry; Juxta-papilary duodenal diverticulum; Cholangiopancreatography, endoscopic retrograde; Choledocholithiasis; Sphincter of Oddi pressure; Common bile duct pressure

Is LigaSure a safe cystic duct sealer? An ex vivo study

To compare the efficacy and safety of both mechanical methods (clips) and electrosurgical instruments, harmonic scalpel (HS) and LigaSure (LS), for securing the cystic duct during laparoscopic cholecystectomy (LC). During the study period from October 2010 to October 2012, 458 patients with gallbladder stones underwent LC. A total of 38 patients were excluded from the study for different reasons. The gallbladder was excised laparoscopically through the traditional method. The gallbladder specimens of the patients were divided into three equal groups randomly, and the distal part of the cystic duct was sealed exvivo using ligaclips (Group A), HS (Group B), and LS (Group C). The gallbladders were then connected to a pneumatic tourniquet device and we very gradually increased the pressure with air. The bursting pressure of the cystic duct (CDBP) was measured and differences between the three groups were calculated. The mean CDBP was 329.7±38.8mmHg in the ligaclip group, 358.0±33.1mmHg in the HS group, and 219.7±41.2mmHg in the LS group. A comparison of the mean CDBP between the groups indicated the superiority of HS over ligaclip and LS. CDBP was significantly higher in the ligaclips group compared with the LS group (p<0.001). HS and ligaclips were found to be safe sealers as their mean CDBP was found to be higher (>195mmHg) than the maximum common bile duct pressure, whereas for LS the CDBP range was 150-297mmHg, indicating that it is not safe for sealing. HS is a safe alternative to clips. In fact, it was even safer than clips. By contrast, LS is not safe for cystic duct sealing.

Effects of cholecystectomy on the changes of motility of Beagle dogs' sphincter of Oddi.

To observe the effect of cholecystectomy on the changes of motion pattern of Beagle dogs' sphincter of Oddi (SO), and investigate the modulatory role of nitric oxide (NO) and cholecystokinin (CCK) in the regulation of SO. Pressure of common bile duct, SO motility, response to bolus injections of cholecystokinin (CCK, 20 ng/kg and 100 ng/kg), basal pressure (BP) and phasic contraction amplitude (PCA) were measured respectively by manometry in six Beagle dogs before and after cholecystectomy. After cholecystectomy, the pressure and diameter of common bile ducts (CBD) was significantly increased (p<0.01); BP and phasic contraction frequency (PCF) were also increased, however, no significant differences were found between the two groups; the SO motilities was not significantly changed. The relaxation responded to physiological dose of CCK (20ng/kg) was decreased, while bolus-dose of CCK (100ng/kg) induced rapid contractions and decreased PCA after cholecystectomy. The regulation pattern of SO pressure modulated by NO and its inhibitor had changed after cholecystectomy. After cholecystectomy in Beagle dogs, no obviously change of motion pattern of SO was observed through self-compensation, but these compensations may lead to some changes of regulation pattern of CCK and NO on SO.

Roles of sphincter of Oddi motility and serum vasoactive intestinal peptide, gastrin and cholecystokinin octapeptide.

To investigate roles of sphincter of Oddi (SO) motility played in pigment gallbladder stone formation in model of guinea pigs. Thirty-four adult male Hartley guinea pigs were divided randomly into two groups: the control group and pigment stone group. The pigment stone group was divided into 4 subgroups with 6 guinea pigs each according to time of sacrifice, and were fed a pigment lithogenic diet and sacrificed after 3, 6, 9 and 12 wk. SO manometry and recording of myoelectric activity of the guinea pigs were obtained by multifunctional physiograph at each stage. Serum vasoactive intestinal peptide (VIP), gastrin and cholecystokinin octapeptide (CCK-8) were detected at each stage in the process of pigment gallbladder stone formation by enzyme-linked immunosorbent assay. The incidence of pigment gallstone formation was 0%, 0%, 16.7% and 66.7% in the 3-, 6-, 9- and 12-wk group, respectively. The frequency of myoelectric activity decreased in the 3-wk group. The amplitude of myoelectric activity had a tendency to decrease but not significantly. The frequency of the SO decreased significantly in the 9-wk group. The SO basal pressure and common bile duct pressure increased in the 12-wk group (25.19 ± 7.77 mmHg vs 40.56 ± 11.81 mmHg, 22.35 ± 7.60 mmHg vs 38.51 ± 11.57 mmHg, P < 0.05). Serum VIP was significantly elevated in the 6- and 12-wk groups and serum CCK-8 was decreased significantly in the 12-wk group. Pigment gallstone-causing diet may induce SO dysfunction. The tension of the SO increased. The disturbance in SO motility may play a role in pigment gallstone formation, and changes in serum VIP and CCK-8 may be important causes of SO dysfunction.

A rabbit model for simultaneous recording the electromyography of the gallbladder and sphincter of Oddi and the pressure of gallbladder and common bile duct

Objective To investigate an animal model for recording the electromyography (EMG) of the gallbladder/sphincter of Oddi and the pressure of gallbladder and common bile duct.Methods The animal model was established in 6 rabbits.A 7F central venous catheter was adopted to penetrate into the gallbladder through the liver.A pair bipolar platinum electrode was stitched onto the gallbladder at the serosal side.Another 7F central venous catheter with a pair bipolar platinum electrode was used to insert into the common bile duct near the sphincter of Oddi (SO).The signal of myoelectrical activity of SO and the gallbladder was recorded through a multi-channel physiological instrument.Meanwhile the changes in the pressure of the gallbladder and common bile duct were observed.Results The spike potential of SO in rabbits was above 0.05 mV,and the most value was 0.26 mV.The frequency of the spike potential was 2 times/min.The slow wave potential of SO was below 0.05 mV,and the frequency was 8-11 times/min.The pressure of gallbladder was 15 cm H2O (6.83-15.00 cm H2O).The pressure of common bile duct was 22 cm H2O (11-22 cm H2O).The EMG of gallbladder was unclear.Conclusion Rabbits can be used to establish the animal model recording the EMG of gall bladder and SO,and the pressure of common bile duct and gallbladder simultaneously,which provides a method for studying the myoelectric activity of SO and gallbladder motility. Key words: Gallbladder; Sphincter of Oddi; Myoelectric activity; Rabbit

PTU-019 Methadone use is associated with the development of common bile duct dilatation among patients with hepatitis C: results of a retrospective cohort study

IntroductionThe synthetic opioid Methadone is widely used in the treatment of opioid dependence. Opioids are known to induce spasm of the sphincter of Oddi, increase common bile duct (CBD) pressures...

Changes of the sphincter of Oddi motility in dog after cholecystectomy

To determine the effect of cholecystectomy on the motility of the sphincter of Oddi (SO). Pressures of common bile duct (CBD), SO motility and its response to bolus injections of cholecystokinin (CCK, 20 ng/kg and 100 ng/kg) were detected respectively by manometry in eight Beagle dogs before and after cholecystectomy. After cholecystectomy the CBD pressure increased 2.18 ± 1.86 mmHg, while the cyclical motion pattern of SO still existed but with a shortened cycle duration. The basal pressure (BP), phasic contraction amplitude (PCA), phasic contraction frequency (PCF) and its mode of propagation did not change significantly. Under the stimulation of CCK after cholecystectomy, although the motion patterns of SO were similar to those before cholecystectomy, the greatest inhibitory efficacy of BP and PCA all decreased with the prolonged excitement duration and the increased percentage of retrograde contraction. Shortly after a cholecystectomy in Beagle dogs, the CBD pressure increased, SO motilities did not change significantly during the interdigestive phase except with a shortened cycle duration. Its relaxation responded to CCK was weakened with a confused contraction pattern.

Biliary manometry in patients with cholelithiasis

Objective To explore the relationship between cholelithiasis and the function of sphincter of Oddi （SO）. Methods To identify the existence of calculi, choledochoscopy was performed in patients 6 weeks after exploration of the common bile duct （CBD） and T tube drainage, in which 71 were patients with stones in gall bladder, CBD or intra-hepatic bile duct, and 9 with trauma of pancreas or liver. Biliary manometry was performed after choledochoscopy, and an additional manometry was applied after calculus removal if calculi were detected. The indices measured included SO basal pressure （ SOBP）, amplitude of SO contractions （ SOCA）, frequency of SO contractions （SOF） and CBD pressure （CBDP）. The patients with cholelithiasis were classified into cholecystolithiasis group, choledocholithiasis group, and hepatolithiasis group according to the position of calculi. Patients with trauma were assigned as the control group. Results All variables in 50 patients with choledocholithiasis were similar before and after the procedure. The variables in patients with cholecystolithiasis and choledocholithiasis had no difference from those of the control （ P 〉 0.05）. The SOBP and SOCA of patients in hepatolithiasis group were lower than those of the control group （ P 〈 0. 05）, while no difference in SOF was detected （ P 〉 0. 05 ）. Conclusion The function of SO in patients with hepatolithiasis is abnormal （decrease in SOBP and SOCA）. Biliary manometry cannot be the reliable evidence for the existence of calculi in bile duct. Key words: Biliary calculi; Sphincter of Oddi; Manometry

Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin

To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux by measuring the radioactivity of Tc99m-labeled diethylene triamine penta-acetic acid (DTPA) in the bile and whether the patients with duodenal-biliary reflux have sphincter of Oddi hypomotility, by measuring the level of plasma and serum gastrin of the patients. Finally to if there is close relationship among sphincter of Oddi hypomotility, duodenal-biliary reflux and gastrointestinal peptides. Forty-five patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group. The level of plasma and serum gastrin of the patients and of 12 healthy volunteers were measured by radioimmunoassay. Thirty-four were selected randomly to undergo choledochoscope manometry. Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duration of contractions (SOD), duodenal pressure (DP) and common bile duct pressure (CBDP) were scored and analyzed. Sixteen (35.6%) patients were detected to have duodenal-biliary reflux. SOBP, SOCA and CBDP in the reflux group were much lower than the control group (t=5.254, 3.438 and 3.527, P<0.001). SOD of the reflux group was shorter than the control group (t=2.049, P<0.05). The level of serum gastrin and plasma motilin of the reflux group was much lower than the control group (t= -2.230 and -2.235, P<0.05). There was positive correlation between the level of plasma motilin and SOBP and between the level of serum gastrin and SOBP and CBDP. About 35.9% of the patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux. Most of them have sphincter of Oddi hypomotility and the decreased level of plasma motilin and serum gastrin. The disorder of gastrointestinal hormone secretion may result in sphincter of Oddi dysfunction. There is a close relationship between sphincter of Oddi hypomotility and duodenal-biliary reflux.