Clinical aspects of sphincter of oddi function and dysfunction

Abstract

The sphincter of Oddi (SO) functions to regulate the flow of bile and pancreatic juices as well as to prevent the reflux of duodenal contents into the pancreatobiliary system. When dysfunction of the sphincter occurs, symptoms develop relating to either the biliary or pancreatic portions of the sphincter. The mechanism of this dysfunction remains speculative. SO manometry remains the "gold standard" to correctly diagnose the disorder and stratify therapy. Division of the sphincter is effective for SO stenosis, but there is no proven therapy for SO dyskinesia.

Bio-sensor system discriminating between the biliary and pancreatic ductal systems

“…This detection limit should be satisfactory for the clinical application of this device even though there may be a mixture of the bile and pancreatic juice in the common channel of the sphincter of Oddi. For manometric assessment of sphincter of Oddi function, the manometry catheter is initially advanced well into either duct before the pull-through protocol is commenced [10]. Consequently, the catheter tip will be exposed to a continuous flow of bile or pancreatic juice.…”

“…Moreover, the procedure time could be shorter and consequently the amount of perfusate entering the pancreatobiliary systems will be reduced, thereby reducing the incidence of acute pancreatitis [4,10].…”

“…This procedure is used to evaluate the biliary and pancreatic components of the sphincter [4,10]. Acute pancreatitis is a major complication of sphincter of Oddi manometry, occurring in 8-17% of patients [7,8].…”

“…The traumas associated with multiple cannulations (catheter insertion into the ducts) are two of several factors that are believed to contribute to the incidence of acute pancreatitis [9]. The cannulation of the desired duct can also be difficult due to the ''blinded'' nature of the procedure and confirmation of the correct duct requires fluoroscopy after injection of contrast [10]. This also adds to the procedure duration.…”

Sphincter of Oddi dysfunction associated with choledochal cyst

“…It is impossible to know whether the sphincter dysmotility seen in these cases is a primary or secondary phenomenon given that there are no premorbid manometric tracings for comparison. The exact cause of SO dysfunction is unknown, but there is evidence to implicate a defect of the neural connections that coordinate the interaction between the duodenum, biliary tract, and SO leading to SO dysmotility 19 . The APBJ could disturb the normal neural connections leading to dysmotility.…”