STUDIES ON THE ETIOLOGY OF CHRONIC PANCREATITIS WITH SPECIAL REFERENCE TO ENDOSCOPIC MANOMETRY OF SPHINCTER OF ODDI AND QUANTITATIVE CHOLESCINTIGRAPHY

Abstract

Motor disorders of the sphincter of Oddi may be one of the etiology of chronic pancreatitis. To elucidate this hypothesis, endoscopic measurement of the sphincter of Oddi pressures and cholescintigraphic evaluation of papillary function were performed in patients with chronic pancreatitis and controls. Infused open manometric system (infusion rate 0.17 ml/min) was applied to obtain a recording of the sphincter of Oddi motor activity in patients with chronic pancreatitis (n= 23) and controls (n=13). From this record the author measured systolic pressures, diastolic pressures, cycles, and in addition, the area surrounded by phasic waves and the base line for one minute (index A), and the area surrounded by phasic waves and the line connecting each bottom of the waves for one minute (index B). As a result, systolic pressures (48.9 + 16.1 mmHg), diastolic pressures (33.9 ± 14.3 mmHg), index A (10.4 ± 3.2 cm²/min) and index B (3.1 ± 0.9 cm²/min) in patients with chronic pancreatitis were significantly (p <0.01) higher than those in controls (28.3 + 8.3 mmHg, 19.5 ± 7.6 mmHg, 6.1 ± 1.7 cm²/min, 1.7 + 0.9 cm²/min, respectively). And systolic pressure differences (9.4 ± 4.1 mmHg), diastolic pressure differences (6.7 ± 3.3 mmHg), cycle differences (3.1±2.1 sec) on two consecutive waves in patients with chronic pan-creatitis were significantly (p <0.01) higher than those in controls (4.3 ± 3.8 mmHg, 2.8 ± 2.2 mmHg, 1.3±0.7 sec, respectively). Therefore irregular waves were more frequent in patients with chronic pancreatitis. Next, the cholescintigraphic examination using Tc-99m-IDA revealed that the CD time, which is the time from the appearance of image on common hepatic duct to that of duodenum, was significantly (p <0.01) longer in patients with chronic pancreatitis (44.1 ± 22.4 min, n=27) than controls (18.5±17.3 min, n=24). In summary, increased papillary resistance in patients with chronic pancreatitis resulted in retension of pancreatic juice. Papillary dysfunction is proved to play a role in the pathogenesis of chronic pancreatitis.