Blaut U, Sherman S, Fogel E, Lehman G A
Department of Pathophysiology, Faculty of Medicine, Jagiellonian University, Cracow, Poland.
Gastrointest Endosc. 2000 Nov;52(5):624-9. doi: 10.1067/mge.2000.108717.
When sphincter of Oddi manometry (SOM) and endoscopic retrograde cholangiopancreatography are performed at the same session, SOM is usually performed immediately before ductography because of concern about the accuracy of the manometric recording after contrast medium injection. However, it would be preferable to inject contrast medium first to identify other causes for a patient's symptoms, allowing selective use of SOM. The aim of this study was to evaluate the effect of cholangiography on sphincter of Oddi (SO) basal pressure.
Twenty-five patients with suspected SO dysfunction were prospectively studied. Conventional station pull-through manometry of the biliary part of the sphincter was performed before and after cholangiography. The intraductal pressure and basal sphincter pressure were evaluated.
The mean intraductal pressure was 8+/-5.5 mm Hg before and 13.3+/-6.8 mm Hg after contrast medium injection (p< 0.01). However, the basal sphincter pressure was not significantly altered (52.9+/-42.1 mm Hg vs. 55.1+/-38.1 mm Hg, p = 0.52). Concordance (normal vs. abnormal) between the basal sphincter pressure before and after ductography was seen in 24 of 25 patients (96%).
Intraductal installation of contrast medium immediately before SOM infrequently alters SO basal pressure in a clinically significant manner. We therefore believe that this sequence can be utilized in clinical practice.
当在同一次检查中进行Oddi括约肌测压（SOM）和内镜逆行胰胆管造影时，由于担心注射造影剂后测压记录的准确性，SOM通常在胆管造影之前立即进行。然而，最好先注射造影剂以确定患者症状的其他原因，从而选择性地使用SOM。本研究的目的是评估胆管造影对Oddi括约肌（SO）基础压力的影响。
对25例疑似SO功能障碍的患者进行前瞻性研究。在胆管造影前后对括约肌胆管部分进行传统的逐点牵拉测压。评估导管内压力和括约肌基础压力。
注射造影剂前平均导管内压力为8±5.5 mmHg，注射后为13.3±6.8 mmHg（p<0.01）。然而，括约肌基础压力没有显著改变（52.9±42.1 mmHg对55.1±38.1 mmHg，p = 0.52）。25例患者中有24例（96%）在胆管造影前后括约肌基础压力（正常与异常）具有一致性。
在SOM之前立即在导管内注入造影剂很少会以具有临床意义的方式改变SO基础压力。因此，我们认为这种顺序可用于临床实践。
