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An endoscopic manometric technique was applied to the study of intraductal biliary and pancreatic pressures and sphincter activity in normal subjects. A perfused system using a modified endoscopic retrograde cholangiopancreatography catheter was tested and found to provide reliable ductal and phasic recordings. Twenty-five healthy volunteers, aged 19-37, underwent endoscopic manometry under diazepam sedation. Distinct zones of high-pressure phasic activity were identified on pull-through from the pancreatic duct and common bile duct at mean distances of 4.5 and 5.0 mm, respectively, from the papillary orifice with frequencies of 7.0 +/- 1.8 (mean +/- SD) and 5.6 +/- 2.4 waves/min, respectively. These were considered to represent separate pancreatic duct and bile duct sphincters. Peak pancreatic duct sphincter pressure (47.6 +/- 8.2 mm Hg) and bile duct sphincter pressure (57.2 +/- 10.7 mm Hg) were similar. Pancreatic duct pressure was 11.4 +/- 3.0 mm Hg and common bile duct pressure was 3.0 +/- 2.5 mm Hg. Values were adjusted to duodenal pressure as zero reference. The ductal and sphincteric pressures reported in this study provide a basis for the assessment of physiological, pharmacological, pathophysiological, and surgical effects on this area.

SUMMARY Endoscopic manometry was used to measure pancreatic duct, common bile duct, pancreatic duct sphincter and bile duct sphincter pressures in 43 healthy volunteers and 162 patients with a variety of papillary, pancreatic and biliary disorders. Common bile duct pressure was significantly raised after cholecystectomy, with common bile duct stones and papillary stenosis but pancreatic duct pressure only in papillary stenosis. After endoscopic sphincterotomy mean common bile duct pressure fell from 11-2 to 1.1 mmHg and pancreatic duct pressure from 18.0 to 11.2 mmHg. Distinct pancreatic duct sphincter and bile duct sphincter zones were identified as phasic pressures of 3-12 waves/minute on pull-through from pancreatic duct and common bile duct to duodenum. Pancreatic duct sphincter pressures were higher with common bile duct stones and stenosis whereas bile duct sphincter pressures were higher in pancreatitis and stenosis. Bile duct sphincter activity was present in 60% of patients after surgical sphincteroplasty but 21% of patients after endoscopic sphincterotomy. Endoscopic manometry facilitated the diagnosis of papillary stenosis, has allowed study of papillary pathophysiology and has shown a functional inter-relationship between the two sphincteric zones.

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An endoscopic manometric technique was used to investigate the effects of exogenous secretin on pancreatic duct, common bile duct, pancreatic duct sphincter, and bile duct sphincter pressures in 20 healthy volunteers. Synthetic secretin was infused intravenously at rates of 8.05, 16.1, 32.2, 64.4, 129, 258, and 516 ng/kg/hr, and plasma secretin concentrations were measured by a radioimmunoassay. Secretin produced a significant fall in peak and trough pancreatic duct sphincter pressures from basal values of 48.2 +/- 7.9 mm Hg (mean +/- SD) and 16.9 +/- 7.7 mm Hg, respectively, to 34.4 +/- 6.8 mm Hg and 11.2 +/- 5.8 mm Hg (P less 0.005), respectively, at a mean plasma secretin concentration of 16 pg/ml (during an infusion rate of 32.2 ng/kg/hr). Higher infusion rates had no additional effect. Pancreatic duct pressure became significantly elevated above basal (11.5 +/- 4.0 mm Hg) at the two highest secretin rates. Secretin had no effect on common bile duct or bile duct sphincter pressures. Plasma secretin concentrations were within the postprandial range during the lowest four secretin infusion rates. We conclude that secretin produces selective physiological relaxation of the pancreatic duct sphincter.

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