SPHINCTER OF ODDI MOTOR ACTIVITY IN PATIENTS WITH MALFUSION OF THE PANCREATICOBILIARY DUCTS

COMPARISON OF THOSE WITH AND WITHOUT CONGENITAL CHOLEDOCHAL CYST

Abstract

Sphincter of Oddi motor activity was investigated in ten patients with malfusion of the pancreaticobiliary ducts (MPBD) and in six controls by endoscopic manometry under fluoroscopy. Five of the ten patients had a congenital choledochal cyst (CCC group) and the others had a normal caliber bile duct (non-CCC group). Characteristic phasic wave activity was observed in the sphincter segment in all subjects. Although those with MPBD had a longer common channel (16.5±3.1 mm in CCC group, 24.6±2.0 mm in non-CCC group), the length of the sphincter segment with phasic wave activity was not different among the three groups. Phasic wave activity was not seen at the junction of the pancreatic and bile ducts in the disease groups except for one patient. Amplitude of the phasic contractions was significantly higher in the CCC group than in controls (p<0.005). Bile obtained from within the bile duct in the disease gruops showed very high concentra-tion of amylase. Morphine given to cause spasm of the sphincter increased basal pressure and frequency of the phasic waves in all controls and in two patients with MPBD studied. Manometry with morphine stimulation was complicated by acute pancreatitis only in one patient with MPBD. These findings suggest that contractions of the sphincter of Oddi in patients with MPBD may contribute to influx of bile and pancreatic juice into the pancreatic and bile ducts respectively, leading to various pathologic conditions associated with this anomaly.