Evaluation of biliary pressure by perfusion method and its significance.

Suzuki, Noriyoshi; Takahashi, Wataru; Uematsu, I; Satô, Toshio

doi:10.1620/tjem.139.121

Cited by 7 publications

(8 citation statements)

References 2 publications

(3 reference statements)

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“…The RP has been believed to express the static pressure free from any load in the bile duct [8]. Our analysis has shown that the vol ume and compliance of the biliary tree are very important in maintaining the RP.…”

Section: P (Cm H 2 O)mentioning

confidence: 86%

“…Boeckl et al [9] reported that the PP was a sensitive parameter expressing pathologic changes in the common bile duct. However, Suzuki et al [8] pointed out that the PP was likely to be affected by a variety of factors, such as the ductal diameter, mural elasticity, and resis tance at the choledochal terminus. In 73% of the patients in this study, the PP with the balloon deflated was equal to that with the balloon inflated.…”

Section: P (Cm H 2 O)mentioning

confidence: 99%

“…Suzuki et al [8] pointed out that the elevation of the RdP suggested some disease of the biliary tree. However, in our series, the RdP was closely connected with the volume and compliance of the biliary tree.…”

Section: P (Cm H 2 O)mentioning

confidence: 99%

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New Intraoperative Biliary Manometric Technique Using a Balloon Catheter – Selective Evaluation of Papillary Function

Kubota¹,

Itoh²,

Shibayama³

et al. 1989

Eur Surg Res

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Papillary function in cholecystolithiasis patients was examined by intraoperative biliary manometry using a new balloon catheter. Pressure measurement was performed in each patient with the balloon deflated and inflated. When the balloon was inflated, the influence of the volume and compliance of the biliary tree was minimized to yield a precise evaluation of papillary function. From our analysis, resting pressure, residual pressure, onset time, and recovery time proved to be influenced by the volume and compliance of the biliary tree. Therefore, these four parameters could not reflect the papillary function exactly. On the other hand, perfusion pressure was not affected by the volume and compliance of the biliary tree. Perfusion pressure was thought to be generated by the resistance of the choledochal outlet and reflect the papillary function. In this study, our balloon catheter proved to be very useful in minimizing the influence of the volume and compliance of the biliary tree. And it is concluded that perfusion pressure is the best parameter to evaluate the resistance of the sphincter of Oddi or papillary function.

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Section: P (Cm H 2 O)mentioning

confidence: 86%

Section: P (Cm H 2 O)mentioning

confidence: 99%

See 1 more Smart Citation

New Intraoperative Biliary Manometric Technique Using a Balloon Catheter – Selective Evaluation of Papillary Function

Kubota¹,

Itoh²,

Shibayama³

et al. 1989

Eur Surg Res

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“…The intraductal pressure curve was recorded according to the procedure of Suzuki et al [3], and the elevation time, the perfusion pressure, the reduction time and the residual pressure were deter mined ( fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…The normal physiological daily bile flow is estimated to be approximately 600-800 ml/24 h, namely 0.42-0.56 ml/min [1], At surgery in gallstone disease cases, we have mea sured the intraductal pressure by perfusing a 2-fold vol ume of physiological bile excretion (constant perfusion method at 1.2 ml/min) [2,3] to examine the papillary passage. We have frequently encountered patients with a dilated bile duct who showed no abnormality in this examination, probably because the functioning of their sphincter of Oddi was nearly intact.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 1989

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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.

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Cholangio‐venous reflux of biliary contents through paracellular pathways between hepatocytes in patients with acute cholangitis

Takada

Takikawa

Sawada

et al. 2021

J Hepato Biliary Pancreat

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Background We re‐analyzed data on cholangio‐venous reflux from a clinical study conducted prospectively on 22 patients in 1974. Method Direct cholangiography was performed with indocyanine green (ICG) mixed into UrographinR under monitoring of intrabiliary pressure, and the participants were allocated to three groups according to whether ICG leakage into the blood, signs of infection, or both, were present. Results The intrabiliary pressure of six patients negative for both ICG leakage and signs of infection was approximately 19.5 (median, [range 18‐22]) cmH2O. In contrast, for the five patients positive for ICG leakage but negative for signs of infection, the intrabiliary pressure was higher (median 32.0 [range 27‐41) cmH2O]. The 11 patients positive for both ICG leakage and signs of infection had the highest intrabiliary pressure (median 48.0 [range 33‐77] cmH2O). Our analyses revealed that, as the intrabiliary pressure increased, the status of ICG leakage and signs of infection appeared in a stepwise fashion. Conclusion Our findings suggest that the tight junctions sealing the bile canaliculi deteriorated with increasing intrabiliary pressure, resulting in reflux of the biliary contents into the vascular system via paracellular pathways between hepatocytes.

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Evaluation of biliary pressure by perfusion method and its significance.

Cited by 7 publications

References 2 publications

New Intraoperative Biliary Manometric Technique Using a Balloon Catheter – Selective Evaluation of Papillary Function

New Intraoperative Biliary Manometric Technique Using a Balloon Catheter – Selective Evaluation of Papillary Function

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

Cholangio‐venous reflux of biliary contents through paracellular pathways between hepatocytes in patients with acute cholangitis

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Evaluation of biliary pressure by perfusion method and its significance.

Cited by 7 publications

References 2 publications

New Intraoperative Biliary Manometric Technique Using a Balloon Catheter &ndash; Selective Evaluation of Papillary Function

New Intraoperative Biliary Manometric Technique Using a Balloon Catheter &ndash; Selective Evaluation of Papillary Function

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

Cholangio‐venous reflux of biliary contents through paracellular pathways between hepatocytes in patients with acute cholangitis

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New Intraoperative Biliary Manometric Technique Using a Balloon Catheter – Selective Evaluation of Papillary Function

New Intraoperative Biliary Manometric Technique Using a Balloon Catheter – Selective Evaluation of Papillary Function