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Does endoscopic sphincterotomy destroy the function of Oddi's sphincter?
P M Heinerman1, A H Graf, O Boeckl
1Department of Surgery, Gastroenterological Surgery, Salzburg General Hospital, Austria.
Objective:
To evaluate the possible destruction of Oddi's sphincter by endoscopic sphincterotomy (ES).
Design:
Prospective, nonrandomized control trial. The study was done from the beginning of 1986 to the end of 1991.
Setting:
The Department of Surgery, Salzburg (Austria) General Hospital.
Patients:
Ninety-one patients with cholecystolithiasis and concomitant different diseases of the common bile duct. Ninety-five patients exclusively having cholecystolithiasis served as the control group.
Interventions:
Patients with cholecystolithiasis plus concomitant different diseases of the common bile duct underwent preoperative ES and, at a second intervention, conventional cholecystectomy. Patients with cholecystolithiasis only underwent elective conventional cholecystectomy.
Main Outcome Measures:
During the cholecystectomy, three pressure and flow variables were routinely measured in the common bile duct: the natural resting pressure, the maximum pressure after the standardized injection of physiologic saline solution, and the normalizing time (the time required for the reappearance of the initial resting pressure).
Results:
The statistical comparison of the two groups showed no significant deviations regarding the resting pressure (P < .4), whereas the maximum pressure was significantly lower (P < .01) in the group that underwent ES. The normalizing time of patients who underwent ES was not statistically different (P < .375) from that of the control group patients.
Conclusion:
The function of Oddi's sphincter is changed but not destroyed following ES.