Monitoring the pressure of the sphincter of Oddi by percutaneous transhepatic choledochoscopy: new method for evaluating motor function.

The pressure of the sphincter of Oddi was measured in 40 patients using a thin microtransducer introduced via percutaneous transhepatic choledochoscopy. Choledochograms of the Vaterian bile duct were classified into four types: N (normal), I, II and III. Judging from the length of the Vaterian bile duct and the degree of fibrosis observed in the biopsy specimens, duodenal papillitis was found to be more severe in Type III than in Type II. Nevertheless the systolic pressure was significantly lower in Type III. We considered that when duodenal papillitis is considerably advanced, the force of contraction of the sphincter is reduced. In addition, based on choledochoscopic observations, as duodenal papillitis increased in severity, the incidence of an irregular shape at the end of the common bile duct during diastole increased. The indications for endoscopic sphincterotomy were determined based on the pressure of the sphincter of Oddi in patients with normal duodenal papilla. In the 26 patients in whom the procedure was not indicated, no gallstones developed. In the 3 patients in whom the procedure was indicated and performed, gallstones have not developed. However, 3 of the 6 patients in whom the procedure was indicated but not performed developed gallstones. This method is useful in evaluating the motor function of the sphincter of Oddi under relatively physiological conditions.