Wehrmann T, Schmitt T, Schönfeld A, Caspary W F, Seifert H
Dept. of Internal Medicine II, J. W. Goethe University Hospital, Frankfurt am Main, Germany.
Endoscopy. 2000 Jun;32(6):444-51. doi: 10.1055/s-2000-647.
Endoscopic perfusion manometry (PM) of the sphincter of Oddi (SO) requires expensive equipment which is relatively large and uncomfortable to handle in the endoscopic retrograde cholangiopancreatography (ERCP) setting. Furthermore, the volume load of the biliopancreatic system may contribute to the increased risk of pancreatitis after SO manometry.
The newly developed small and lightweight microtransducer system consists of a portable data-logger with integrated online display which is connected to a 4-Fr manometry probe. The manometry catheter is inserted endoscopically into the biliopancreatic system via a 7-Fr Teflon sheath. SO motility can be observed online on the display but the data can also be stored for later analysis on a personal computer (PC). To validate the new method, 15 patients with suspected biliary SO dysfunction underwent both PM as well as microtransducer manometry (MTM) in randomized order. Thereafter, 50 consecutive patients with suspected biliary or pancreatic SO dysfunction were investigated solely by MTM.
PM was possible in 13 of 15 cases whereas MTM could be performed in all 15 patients. The basal SO pressure tended to be lower (approximately 5 mmHg) when measured with the MTM, compared with the PM method, but there was a significant and nearly linear correlation between the basal SO pressures obtained by both methods (r=0.98, P<0.001). SO dysfunction was diagnosed in the same five patients using both methods. Furthermore, the parameters of phasic SO motility were highly comparable when measured by MTM and PM. MTM was carried out successfully in 49 of 50 patients and only one MTM probe was used for all examinations, without malfunction. The endoscopist was able to diagnose SO dysfunction (by immediate observation of SO motility on the display) in 19 of 20 patients (when compared with the later PC analysis) and SO motility was judged correctly as normal in the remaining 29 cases. MTM was repeated in five patients with SOD 1-6 weeks after the first examination and the manometric findings were confirmed in all cases. Mild postmanometry pancreatitis was observed in only one of 49 patients (2%).
Endoscopic MTM is a reliable, safe, very easy to handle, and low-cost alternative for the clinical assessment of SO motility.
内镜下Oddi括约肌（SO）灌注测压法（PM）需要昂贵的设备，该设备相对体积较大，在内镜逆行胰胆管造影（ERCP）操作中使用起来不太方便。此外，胆胰系统的容量负荷可能会增加SO测压后胰腺炎的风险。
新开发的小型轻便微传感器系统由一个带有集成在线显示屏的便携式数据记录器组成，该记录器连接到一个4F的测压探头。测压导管通过一个7F的聚四氟乙烯护套经内镜插入胆胰系统。SO的运动情况可在显示屏上在线观察，但数据也可存储起来供以后在个人电脑（PC）上分析。为验证该新方法，15例疑似胆源性SO功能障碍的患者按随机顺序分别接受了PM以及微传感器测压法（MTM）。此后，50例连续的疑似胆源性或胰源性SO功能障碍的患者仅接受了MTM检查。
15例患者中有13例成功进行了PM，而所有15例患者均成功进行了MTM。与PM法相比，用MTM测量时SO的基础压力往往较低（约5 mmHg），但两种方法测得的SO基础压力之间存在显著且近乎线性的相关性（r = 0.98，P < 0.001）。两种方法诊断出相同的5例SO功能障碍患者。此外，通过MTM和PM测量时，SO的阶段性运动参数具有高度可比性。50例患者中有49例成功进行了MTM，所有检查仅使用了一个MTM探头，且无故障发生。内镜医师能够（通过在显示屏上即时观察SO的运动情况）在20例患者中的19例中诊断出SO功能障碍（与后来的PC分析相比），其余29例中SO的运动情况被正确判断为正常。5例SOD患者在首次检查后1 - 6周重复进行了MTM，所有病例的测压结果均得到证实。49例患者中仅1例（2%）出现了轻度测压后胰腺炎。
内镜MTM是一种可靠、安全、操作非常简便且低成本的评估SO运动情况的临床替代方法。
