Cholangiomanometry in Dilated Bile Ducts without a Dysfunction of Sphincter of Oddi

Abstract

To elucidate the pathophysiological state of a dilated bile duct without a dysfunction of the sphincter of Oddi, cholangiomanometry has been carried out by the constant perfusion method with a variable perfusion flow involving four increased steps, 1.2, 3.3, 6.6, and 15 ml/min, instead of the single step amount, 1.2 ml/min, of the usual routine procedure. The subjects consisted of 61 patients with benign biliary tract diseases in whom no abnormality was seen in their intraductal pressure curve by the routine constant perfusion method, as well as no residual stones and no passage disturbance in the papillary region. Twenty-nine of these patients showed no dilatation of the bile duct (nondilated group), while the bile duct was dilated in the remaining 32 (dilated group). Differences in these two groups then were compared in terms of their intraductal pressure curve revealed by our four-step perfusion testing. The two groups showed no differences in the baseline pressure, the elevation time (the time that it took to reach the opening pressure of the sphincter after starting perfusion), the perfusion pressure and the residual pressure at any given perfusion rate in pressure curve pattern. However, in the reduction time, the time that it took for the pressure curve to return to the residual pressure after cessation of infusion, while there was no significant difference for both groups at the routine perfusion rate of 1.2 ml/min, at the high perfusion rates of 3.3, 6.6, and 15/min, the dilated group demonstrated a significant delay, which was in proportion to the increased volume of the perfusion. Further, the dilated group also showed a correlation of r = 0.75 between the diameter of the common bile duct and the delay in the reduction time at the high perfusion rates. These findings suggest that a dilated bile duct without a dysfunction of the sphincter of Oddi may develop bile stasis only when the bile secretion is extremely increased, that is 5 times or more of the normal volume, (3,000 ml or more/day). Although it is highly unlikely that such cases will be encountered clinically, it seems safe to say that a dilated bile duct does not necessarily imply a biliary stasis. Therefore, a routine cholangiomanometric study makes it possible to determine whether such a patient requires a sphincteroplasty or an enterobiliary bypass.

Nanobubble-embedded inorganic 808 nm excited upconversion nanocomposites for tumor multiple imaging and treatment

“…Ultrasound scanning does not involve harmful radiation and is generally used for scanning organs to help in medical diagnosis and treatment. 1 However, acoustic impedance is similar in various body organs, thereby resulting in poor resolution of the ultrasound image. 2 Ideal ultrasound contrast agents exhibit high biocompatibility, can be readily metabolized, and possess a significantly different acoustic impedance in biological tissues.…”