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Evaluation of sphincter of Oddi function.

¹Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia.

The Australian and New Zealand Journal of Surgery

|June 1, 1989

Summary

Diagnosing sphincter of Oddi dysfunction, a cause of post-cholecystectomy pain, remains challenging. Endoscopic manometry is the most useful diagnostic tool, identifying stenosis or dyskinetic patterns.

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Area of Science:

Gastroenterology
Biliary System Physiology
Diagnostic Techniques

Background:

Sphincter of Oddi motility disorders are increasingly recognized as a cause of pain after gallbladder removal (cholecystectomy).
Accurate diagnosis of sphincter of Oddi dysfunction is hindered by the sphincter's inaccessible location.
Several diagnostic investigations have been employed to assess these motility disorders.

Purpose of the Study:

To review current diagnostic investigations for sphincter of Oddi dysfunction.
To highlight the utility and limitations of various diagnostic methods.
To define subgroups of sphincter of Oddi dysfunction based on manometric findings.

Main Methods:

Endoscopic manometry is identified as the most valuable diagnostic investigation.
Other methods discussed include the morphine-neostigmine provocation test, radioscintigraphy for bile flow, and pancreatic duct diameter assessment post-secretin.
Challenges in achieving high specificity and sensitivity due to small patient numbers and heterogeneity of abnormalities are noted.

Main Results:

Endoscopic manometry has been instrumental in defining two primary subgroups of sphincter of Oddi dysfunction: one with high basal pressure (stenosis) and another with dyskinetic patterns.
The diagnostic accuracy of various investigations remains difficult to ascertain.
Ongoing prospective studies aim to clarify optimal therapeutic strategies.

Conclusions:

Sphincter of Oddi dysfunction is a significant cause of post-cholecystectomy pain requiring objective diagnosis.
Endoscopic manometry provides crucial data for classifying dysfunction into stenosis or dyskinesia.
Further research is essential to establish definitive diagnostic criteria and guide treatment for sphincter of Oddi motility disorders.

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