To date, endoscopic manometry is the best method for evaluating the function of the sphincter. Sphincter of Oddi manometry (SOM) remains the gold standard to correctly diagnose the sphincter of Oddi dysfunction (SOD) and stratify therapy. Several dynamic abnormalities relating to the intensity, frequency, and propagation of sphincter contractions have been described. However, their clinical use generally has been abandoned in favor of basal sphincter pressure alone, because this measurement is stable over time, and has stronger interobserver reliablility, reproducibility on repeating testing, and is associated with the responsiveness to therapy. A significant elevated risk of pancreatitis was attributed to the technique. The risk of pancreatitits associated with manometric evaluation of the pancreatic sphincter is markedly reduced when manometry is performed with continous aspiration from the pancreatic duct via one of the 3 catheter lumens. This section reviews indications, conscious sedative drugs, techniques, and the appropriate interpretations of SOM.
Catheters ; Contracts ; Manometry ; Pancreatic Ducts ; Pancreatitis ; Sphincter of Oddi ; Sphincter of Oddi Dysfunction

We evaluated the clinical characteristics of patients with SO dyskinesia(n=16) who were confirmed by ERCP manometry during past 5 years. They were 14 male and 2 female and mean age was 52-year-old(range, 32-75). According to the criteria suggested by Hogan and Geenen, 13 patients were classified into biliary type and 3 patients into pancreatic type. Among the patients with biliary type(n=13), 12 patients fulfilled the criteria for group II dysfunction of SO and 1 patient for group III. Among the patients with pancreatic type(n=3), all fulfilled the criteria for group II. The manometric abnormalities were increased basal pressure(n=4), tachyoddia(n=7), increased retrograde propagation(n=3), tachyoddia and increased retrograde propagation(n=l), and tachyoddia and increased basal pressure(n=l). As treatment, 12 patients received conventional endoscopic sphincterotomy and 3 patients received endoscopic pancreatic sphincterotomy in addition to conventional endoscopic sphincterotomy. Satisfactory results (complete absence or marked reduction of pain) were obtained in 13(87%) out of 15 patients by endoscopic treatment. In conclusion, SO dyskinesia is not so common disease and the detection of patients with SO dyskinesia may increase by frequent application of ERCP manometry.
Cholangiopancreatography, Endoscopic Retrograde ; Dyskinesias ; Female ; Humans ; Male ; Manometry ; Sphincter of Oddi Dysfunction* ; Sphincter of Oddi* ; Sphincterotomy, Endoscopic

BACKGROUND/AIMS: The reproducibility of sphincter of Oddi manometry (SOM) measurements and results of SOM after sphincterotomy has not been studied sufficiently. The aim of our study is to evaluate the reproducibility of SOM and completeness of sphincter ablation. METHODS: The recently published Evaluating Predictors and Interventions in sphincter of Oddi dysfunction (EPISOD) study included 214 subjects with post-cholecystectomy pain, and fit the criteria of sphincter of Oddi dysfunction type III. They were randomized into 3 arms, irrespective of manometric findings: sham (no sphincterotomy), biliary sphincterotomy, and dual (biliary and pancreatic). Thirty-eight subjects had both biliary and pancreatic manometries performed twice, at baseline and at repeat endoscopic retrograde cholangiopancreatography after 1-11 months. Sham arm was examined to assess the reproducibility of manometry, and the treatment arms to assess whether the sphincterotomies were complete (elevated pressures were normalized). RESULTS: Biliary and pancreatic measurements were reproduced in 7/14 (50%) untreated subjects. All 12 patients with initially elevated biliary pressures in biliary and dual sphincterotomy groups normalized after biliary sphincterotomy. However, 2 of 8 subjects with elevated pancreatic pressures in the dual sphincterotomy group remained abnormal after pancreatic sphincterotomy. Paradoxically, normal biliary pressures became abnormal in 1 of 15 subjects after biliary sphincterotomy, and normal pancreatic pressures became abnormal in 5 of 15 patients after biliary sphincterotomy, and in 1 of 9 after pancreatic sphincterotomy. CONCLUSIONS: Our data suggest that SOM measurements are poorly reproducible, and question whether we could adequately perform pancreatic sphincterotomy.
Arm ; Cholangiopancreatography, Endoscopic Retrograde ; Humans ; Manometry* ; Sphincter of Oddi Dysfunction ; Sphincter of Oddi* ; Sphincterotomy, Endoscopic

Recent studies suggest that sphincter of Oddi dysfunction (SOD) is one of the possible causes of unexplained recurrent acute pancreatitis in children. A 14-year-old boy who had suffered from idiopathic recurrent acute pancreatitis was diagnosed with SOD. Abdominal ultrasonography, computerized tomography, and magnetic resonance cholangiopancreatography revealed no evidence of stone, tumor, or pancreatic ductal anomaly. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincter of Oddi manometry (SOM) revealed elevated basal pressure and tachyoddia consistent with SOD. Hence, an endoscopic pancreatic sphincterotomy was performed. We report a case of recurrent acute pancreatitis associated with SOD in a child. ERCP and SOM may be considered in patients with multiple unexplained attacks of pancreatic pain and negative abdominal imaging.
Adolescent ; Child ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Humans ; Manometry ; Pancreatic Ducts ; Pancreatitis ; Sphincter of Oddi ; Sphincter of Oddi Dysfunction

Recent studies suggest that sphincter of Oddi dysfunction (SOD) is one of the possible causes of unexplained recurrent acute pancreatitis in children. A 14-year-old boy who had suffered from idiopathic recurrent acute pancreatitis was diagnosed with SOD. Abdominal ultrasonography, computerized tomography, and magnetic resonance cholangiopancreatography revealed no evidence of stone, tumor, or pancreatic ductal anomaly. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincter of Oddi manometry (SOM) revealed elevated basal pressure and tachyoddia consistent with SOD. Hence, an endoscopic pancreatic sphincterotomy was performed. We report a case of recurrent acute pancreatitis associated with SOD in a child. ERCP and SOM may be considered in patients with multiple unexplained attacks of pancreatic pain and negative abdominal imaging.
Adolescent ; Child ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Humans ; Manometry ; Pancreatic Ducts ; Pancreatitis ; Sphincter of Oddi ; Sphincter of Oddi Dysfunction

Acute recurrent pancreatitis (ARP) refers to a clinical condition characterized by repeated episodes of acute pancreatitis, diagnosed retrospectively after at least the second episode of acute pancreatitis. It is still controversial that acute pancreatitis can progress to chronic pancreatitis, and acute, acute recurrent and chronic pancreatitis is a continuum of disease. The causes of ARP can be divided into mechanical, hereditary and metabolic factor. Despite recent advances in diagnostic technologies, the etiology of ARP still remains unknown in up to 30% of cases. Especially in recurrent episode of idiopathic pancreatitis, a clinician should be considered not only the common causes of ARP, such as gallstone disease and alcohol, but also rare causes of ARP. The common causes of 'idiopathic' recurrent pancreatitis are microlithiasis, sludge, sphincter of oddi dysfunction, pancreas divisum and hereditary pancreatitis. Various treatment options, such as cholecystectomy, endoscopic sphincterotomy, medical and surgery can be applied according to the identified etiology of ARP and treatment should be individualized. Currently, endoscopic treatment is increasingly performed and served as a curative treatment strategy. The medical treatment can be an option in microlithiasis and sludge, but it has limitation in terms of systemic side effect, efficacy and lack of long term outcome. Endoscopic treatment should be considered in selected patients with identifiable cause, and post procedural complication should be considered before endoscopic treatment.
Cholecystectomy ; Diagnosis ; Gallstones ; Humans ; Pancreas ; Pancreatitis* ; Pancreatitis, Chronic ; Retrospective Studies ; Sewage ; Sphincter of Oddi Dysfunction ; Sphincterotomy, Endoscopic

PURPOSE: Biliary dyskinesia was considered as a wastebasket of quasi-biliary disease which could not be clearly explained under the basis of morphologic pathology. This entity was a source of confusion because of misconception and poor understanding. Recent introduction of biliary manometric technique enlightened some of these disorders. We evaluated the cholangiographic morphology of these disorders to clarify and to characterize the some characteristic findings, subsequently in order to help the diagnosis. MATERIALS AND METHODS: Five cases were confirmed by this technique as sphincter of Oddi dysfunction for last 13 months. All patients were female and age range was 53 to 75 years old. All patients were suffered from intermittent and recurrent biliary type pain. RESULTS: ERCP showed five common findings. The common bile duct was dilated over 12ram in all patients. Different from recurrent pyogenic cholangiohepatitis, intrahepatic ducts were proportionally dilated as extrahepatic ducts, in four patients and they branched normally and ductal wall was smooth. Transient or persistent meniscus sign was observed in four patients. All patients showed delayed emptying of contrast media from the common bile duct into the duodenum. Following IV injection of cholecystokinin, persistent meniscus disappeared and contrast media inflowed into the duodenum. CONCLUSION: Identification of all or some characteristic cholangiographic findings may eliminate a cumbersome and painful biliary manometric test for the diagnosis of sphincter of Oddi dysfunction.
Aged ; Biliary Dyskinesia ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystokinin ; Common Bile Duct ; Contrast Media ; Diagnosis ; Duodenum ; Female ; Humans ; Manometry* ; Pathology ; Sphincter of Oddi Dysfunction* ; Sphincter of Oddi*

Botulinum toxin has been used to treat various gastrointestinal tract diseases such as achalasia, diabetic gastroparesis, sphincter of oddi dysfunction, and chronic anal fissures. Recently, it has also been used for the treatment of cricopharyngeal muscle dysfunction. Several studies have reported that botulinum toxin injections may be a safe and effective treatment. Previously, cricopharyngeal muscle dysfunction was treated by mechanical balloon dilation or cricopharyngeal myotomy. Here, we report a case of a 57-year-old man who presented with cricopharyngeal dysphagia due to cerebral infarction and who was successfully treated with endoscopic botulinum toxin injection.
Botulinum Toxins ; Cerebral Infarction ; Deglutition Disorders ; Esophageal Achalasia ; Gastrointestinal Tract ; Gastroparesis ; Humans ; Middle Aged ; Muscles ; Sphincter of Oddi Dysfunction

Functional dyspepsia is a very common disease and there are two types of dyspepsia. One is functional dyspepsia in the gastrointestinal tract and the other is pancreatobiliary dyspepsia. Biliary dyspepsia is caused by biliary tract disease and can even cause biliary pain. Acalculous biliary pain (ABP) is biliary colic without gallstones, it is caused by functional biliary disorder or structural disorders such as microlithiasis, sludges or parasitic infestation like Clonorchiasis. The endoscopic ultrasonography is helpful tool for differential diagnosis of ABP. Although sphincter of Oddi manometry (SOM) is performed for the confirmative diagnosis of sphincter of Oddi dysfunction (SOD), several non-invasive tests have been studied because of some practical limitations and invasiveness of SOM itself. In fact, the most clinically used easy test to diagnose functional biliary disorder is quantitative hepatobiliary scintigraphy and it can distinguish gallbladder dyskinesia, SOD, or combined type. Initial treatment of functional biliary disorder is adequate dietary control and medication, but if the symptoms worsened or recurred frequently, laparoscopic cholecystectomy could be performed with gallbladder dyskinesia. If SOD is suspected, additional SOM should be considered and endoscopic sphincterotomy (EST) can be done according to the outcome. If the SOM is not available, the patient could be diagnosed by stimulated ultrasound.
Biliary Dyskinesia ; Biliary Tract Diseases ; Cholecystectomy, Laparoscopic ; Clonorchiasis ; Colic ; Diagnosis ; Diagnosis, Differential ; Dyspepsia* ; Endosonography ; Gallstones ; Gastrointestinal Tract ; Humans ; Manometry ; Radionuclide Imaging ; Sphincter of Oddi ; Sphincter of Oddi Dysfunction ; Sphincterotomy, Endoscopic ; Ultrasonography

The two most common causes of acute pancreatitis are alcohol and cholelithiasis. Acute recurrent pancreatitis can result from a variety of abnormalities involving the terminal end of the distal choledochus, pancreatic duct, ampulla of Vater and the major duodenal papilla, which in turn may include a papillary stenosis, periampullary neoplasm, choledochocele, sphincter of Oddi dysfunction, and pancreatic ductal adenocarcinoma. Recently a case of recurrent acute pancreatitis associated with aberrant cystic duet insertion at the ampulla of Vater was experienced. Biliary-pancreatic reflux was speculated to be the mechanism responsible for causing this anomalous, recurrent, acute pancreatitis. Another case of acute pancreatitis associated with aberrant cystic duct insertion at the ampulla of Vater was also experienced in a 29-year-old man, 1Jnlike the previous report, our case showed cholestatic features on the initial blood chemistry. An endoscopic retrograde cholangiopancre-atography performed after recovry revealed only aberrant cystic duct insertion at the ampulla of Vater. This anomaly also seems to have played a role in causing acute pancreatitis in this patient. This interesting case is herein reported with a review of the relevant literature.
Adenocarcinoma ; Adult ; Ampulla of Vater* ; Chemistry ; Choledochal Cyst ; Cholelithiasis ; Common Bile Duct ; Constriction, Pathologic ; Cystic Duct* ; Humans ; Pancreatic Ducts ; Pancreatitis* ; Sphincter of Oddi Dysfunction