山莨菪碱和加贝酯对胆总管结石术后胆道动力的影响

目的:观察胆总管结石术后,使用山莨菪碱、加贝酯对胆道和机体的影响.方法:将胆总管结石术后患者65例.随机分为对照组(n=20),山莨菪碱组(n=22)和加贝酯组(n=23),分别于术后1、2、3、4、5及7 d检测胆道压力及血清中内毒素的变化.于术后3、7 d进行99mTc-EHIDA肝胆动态功能显像定量分析.结果:胆道压力术后1、2、3 d,加贝酯组的低于对照组(1.76±0.20 kPa vs 1.84±0.28 kPa;1.60±0.221 kPa vs 1.86±0.20 kPa;1.56±0.22kPa vs 1.74±0.24 kPa,均P<0.05);术后3、4 d,山莨菪碱组和加贝酯组血清中内毒素水平低于对照组(P<0.05);术后3d,30 min十二指肠显影率(DAR)山莨菪碱组、加贝酯组与对照组间有明显差异(P=0.026,0.018);而肝高峰摄取时间(Tmax)、半排时间(T1/2、胆总管高峰摄取时间(Tmax)及半排时间(T1/2差异无显著性.结论:本研究提示术后早期,山莨菪碱组、加贝酯等药物可以促进胆汁排泄,降低血清内毒素水平,其作用机制可能与改善术后Oddi括约肌功能有关.     

薄荷素油对家兔Oddi括约肌收缩性的影响

背景:薄荷素油具有直接松弛消化道平滑肌、利胆等作用。Oddi括约肌作为消化道平滑肌的一部分,具有自主收缩和舒张运动功能,对胆汁排出具有重要意义。目的:探讨薄荷素油对家兔Oddi括约肌收缩性的影响。方法:20只家兔随机分为实验组和对照组,分别向Oddi括约肌处喷洒5 m L薄荷素油溶液或0.9%Na Cl溶液,动态监测Oddi括约肌收缩和压力变化。结果:实验组喷洒薄荷素油溶液后,Oddi括约肌基础压[(10.600±1.712)mm Hg对(17.500±1.581)mm Hg,P0.01]、收缩频率[(6.700±0.823)次/min对(9.000±1.247)次/min,P0.01]和运动指数[(50.400±10.068)mm Hg·次/min对(67.500±19.021)mm Hg·次/min,P0.01]较基线值显著降低,收缩幅度则无明显变化[(7.500±1.080)mm Hg对(7.400±1.264)mm Hg,P0.05];对照组喷洒0.9%Na Cl溶液前后上述各项指标差异均无统计学意义(P0.05)。结论:薄荷素油可能通过抑制Oddi括约肌收缩、降低Oddi括约肌基础压而降低胆汁排出阻力,从而发挥利胆、预防胆固醇结石形成的作用。     

胆石症患者Oddi括约肌压力表现及其意义

目的探讨胆石症与Oddi括约肌（SO）功能的关系。方法对已行外科胆总管探查术患者术后6周进行胆道镜经T管窦道胆道测压,项目包括s0基础压、s0收缩幅度、sO收缩频率、胆总管压力。探查术原因71例为胆石症,分为胆囊结石组（20例）、胆总管结石组（22例）和肝内胆管结石组（29例）;9例因外伤,作为正常对照。胆道镜先明确有无胆道结石,如有结石在取石前后分别测压,如无结石则直接测压。结果胆道镜检查50例存在胆管结石者取石前后各测压指标均无统计学差异。胆囊结石组、胆总管结石组各指标与对照组无明显差异（P〉0．05）;但肝内胆管结石组的S0基础压、s0收缩幅度、胆总管压力均较对照组明显降低[（8．92±-5．87）mmHg比（16．21±3．27）mmHg、（58．89±26．40）mmHg比（106．30±54．28）mmHg、（8．49±6．89）mmHg比（13．56±2．93）mmHg],差异均有统计学意义（P〈0．05）,SO收缩频率无统计学差异（P〉0．05）。结论胆道测压不能作为判断胆管内有无结石的可靠依据;肝内胆管结石患者存在SO功能异常,其SO基础压和收缩幅度、胆总管压力均明显下降。     

胆总管结石术后复发的危险因素

胆总管结石术后复发问题一直未得到很好地解决,结石复发往往需要再次手术,给患者带来巨大痛苦和经济压力。多种危险因素可能介导了胆总管结石的复发,包括胆道感染、胆管狭窄、胆管扩张、胆汁淤积、Oddi括约肌功能障碍、胆汁成分异常、手术方式等,对以上危险因素分别作了分析、论证,总结了相应预防措施。现有研究结果表明,针对每个患者导致结石复发的危险因素作相应防治,可能会降低结石复发率,对预防胆总管结石复发起到积极作用。     

电针肝俞穴、梁丘穴对抑郁型胃溃疡大鼠SS及海马BDNFmRNA的影响

目的:研究电针肝俞穴、梁丘穴对抑郁型胃溃疡大鼠模型生长抑素(somatostatin,SS)及海马脑源性神经营养因子(brain derived neurotrophic factor,BDNF)的影响,探讨电针肝俞穴、梁丘穴对抑郁型胃溃疡的治疗机制.方法:所有大鼠旷场试验后选择合格大鼠60只,按照随机数字表法分为4组:空白组(n=15)、模型组(n=15)、西药组(n=15)、电针组(n=15).除正常组外,剩下的3组建立慢性不可预见性刺激抑郁症合并醋酸烧灼胃溃疡大鼠模型.电针组采用电针肝俞穴、梁丘穴,西药组采用奥美拉唑灌胃4.2 mg/(kg?d).肝俞穴位直刺6 mm,梁丘穴直刺4-5 mm,电针治疗仪给予疏密波型,疏波4 Hz,密波20 Hz,强度以局部皮肤肌肉轻微颤动为度,留针20 min,1次/d,连续6 d,中间休息1 d,2 wk为1个疗程,共13 d.观察大鼠一般情况变化、旷场试验结果、溃疡指数结果,运用免疫组织化学法检测下丘脑、胃窦黏膜组织中SS的表达,RT-PCR法检测海马组织中BDNF的表达.结果:造模后和治疗后模型组旷场试验水平和垂直运动均较空白组明显降低(23.28±4.13 vs 38.35±6.65,9.89±3.31 vs 19.34±2.56;27.19±3.72 vs 38.87±4.89,10.58±2.47vs 20.68±3.54;均P0.01),而治疗后电针组和西药组水平和垂直运动较模型组显著增高(34.78±6.54 vs 27.19±3.72,33.24±4.54vs 27.19±3.72;17.78±2.09 vs 10.58±2.47,16.32±3.01 vs 10.58±2.47;均P0.01).电针组和西药组溃疡指数比模型组有显著降低(2.14±0.75 vs 4.75±0.46;2.10±0.32 vs 4.75±0.46;均P0.01).模型组胃黏膜和下丘脑中SS表达较空白组降低(0.09887±0.0073 vs0.16675±0.0046;0.09500±0.0063 vs 0.14462±0.0050;均P0.05),电针组和西药组SS表达较模型组均增高(0.12562±0.0031 vs 0.09887±0.0073,0.12538±0.0043 vs 0.09887±0.0073;0.11312±0.0054 vs 0.09500±0.0063,0.11900±0.0056 v s 0.09500±0.0063;均P0.05).模型组海马BDNF mRNA含量较空白组显著降低(0.2775±0.00712 vs 0.6899±0.03245;P0.01),电针组海马BDNF mRNA含量比模型组显著增高(0.6547±0.01907 vs0.2775±0.00712;P0.01),西药组与模型组比较含量增高(0.4162±0.0088 vs 0.2775±0.00712;P0.05).以上指标电针组与西药组比较除BDNF mRNA差异有统计学意义(0.6547±0.01907 vs 0.4162±0.0088;P0.01)外余者均无统计学意义(P0.05).结论:电针肝俞穴、梁丘穴可以通过调节脑肠肽SS及海马BDNF的表达水平,对抑郁型胃溃疡起到治疗作用.     

奥狄氏括约肌的运动功能

自奥狄氏于1887年提出在胆总管之末端存在括约肌以来,有关该括约肌如何控制胆汁自胆总管流向十二指肠向有争论。早期研究认为奥狄氏括约肌在禁食时保持关闭,而唯有在餐后方起主动挤压作用将胆汁排入十二指肠。大多数争论之所以存在,其原因在于对该括约肌的研究仅局限于动物实验、胆道病人术中或经T管进行的观察。随着内窥镜及逆行胰胆管造影术等方法的应用,对奥狄氏括约肌的作用机制已得到进一步了解。实验动物中奥狄氏括约肌的运动功能对狗、猫、家兔、猴及负鼠等动物的研究证明奥狄氏括约肌的功能并不依赖十二指肠肌的活动。狗体内研究发现,胆总管下端挤压胆汁,使少量胆汁从胆总管流入十二指肠。近来,又对美洲负鼠的奥狄氏括约肌进行了研究。此种动物的括约肌位于十二指肠之外,故记录括约肌     

电针足三里和阳陵泉穴对家兔胃胆运动及脑肠肽的影响

目的:研究经脉-脏腑相关理论及经穴对相应脏腑的特异性作用．方法:静脉滴注阿托品造成家兔(n=50)胃和 Oddi括约肌运动抑制状态,观察电针家兔足三里穴及阳陵泉穴对胃电及Oddi括约肌肌电的影响并检测血浆和胃窦平滑肌及Oddi括约肌组织中胃动素(MTL)胆囊收缩素(CCK)的含量．结果:静滴阿托品后家兔胃电和Oddi括约肌肌电慢波高活动相平均振幅(P=0．001和快波平均振幅(P=0．028,P=0．001)明显降低;慢波平均频率变化不明显．电针足三里穴和阳陵泉穴对家兔胃电(P=0．020,P=0．0001及Oddi 括约肌肌电(P=0．021,P=0．001)平均振幅有不同程度的兴奋作用,表明经脉-脏腑之间既有直接相关又有间接相关．电针足三里穴和阳陵泉穴可升高胃窦平滑肌、Oddi括约肌组织及血浆中MTL(P=0．000)、CCK((P=0．001)含量．电针足三里穴对胃窦平滑肌和血浆MTL (P=0．020,P=0．001)及血浆CCK(P=0．001)含量升高最显著,差异有显著性意义．Oddi括约肌MTL及胃窦平滑肌、Oddi括约肌CCK以电针阳陵泉穴明显．提示MTL和CCK是参与针刺调整消化道运动的重要脑肠肽物质．结论:电针足三里和阳陵泉穴可促进胃和 Oddi括约肌运动,其机制之一可能为针刺影响外周MTL、CCK的释放,进而调整消化道运动．这种经穴对相应脏腑的调整作用具有相对特异性．     

腹腔镜联合胆道镜胆总管探查一期缝合术治疗胆囊结石合并胆总管结石的临床效果分析

目的探讨腹腔镜联合胆道镜胆总管探查一期缝合术的安全性和有效性。方法回顾性分析2015年7月-2017年7月海南医学院第一附属医院肝胆胰外科收治的76例胆囊结石合并胆总管结石患者,分别行腹腔镜胆囊切除+胆道镜胆总管探查术+一期缝合(PDC组)(n=20)和腹腔镜胆囊切除+胆道镜胆总管探查术+T管引流(TTD组)(n=56),观察2组患者的手术时间、术中出血量、术后胃肠道功能恢复时间、腹腔引流管拔除时间、术后住院天数以及并发症(胆总管残余结石、胆瘘和胆道感染)发生率。术后随访2~12个月。计量资料2组间比较采用t检验,计数资料2组间比较采用χ~2检验。结果所有患者均成功实施腹腔镜手术,无1例中转开腹。PDC组和TTD组患者在手术时间[(106.2±15.8)min vs(147.5±23.2)min]、术后胃肠道功能恢复时间[(32.9±8.1)h vs(49.4±6.5)h]、腹腔引流管拔管时间[(3.5±1.3)d vs(5.7±2.6)d]、术后住院时间[(6.3±1.5)d vs(11.4±2.0)d]进行比较,差异均有统计学意义(t值分别为-2.87、-3.61、-2.64、-26.34,P值分别为0.036、0.021、0.034、<0.001)。2组患者术中出血、术后胆瘘、胆道残余结石和胆道感染方面差异均无统计学意义(P值均>0.05)。结论从有限病例进行初步研究发现,只要选择合适的病例,腹腔镜胆总管探查一期缝合术是安全有效的。     

肠胆反流与Oddi括约肌压力之间的关系

目的:探讨胆石症患者十二指肠胆道反流的发生与Oddi括约肌压力之间的关系.方法:采用口服核素观察十二指肠胆道反流的方法,将51例胆道残石患者分为反流组和对照组,并从中随机双盲选择33例患者进行Oddi括约肌测压研究,比较十二指肠胆道反流的发生与Oddi括约肌压力之间是否存在一定的关系.结果:51例行胆道取石T型管引流术后的患者中有16例检测到十二指肠胆道反流(31%);所选择的33例患者中有10例检测到十二指肠胆道反流(反流组),余23例未检测到反流的作为对照组,反流组Oddi括约肌基础压、收缩波幅、胆总管压显著低于对照组(7.2±3.9 mmHg vs 14.7±11.0 mmHg.53.5±24.5mmHg vs 117.2±65.6 mmHg.5.1±1.6 mmHg vs 11.5±7.4 mmHg.P＜0.05).两组十二指肠压(DP)、Oddi括约肌收缩频率(SOF)及收缩间期(SOD)无显著性差异(P＞0.05).结论:肠胆反流的发生与Oddi括约肌收缩波幅、基础压及胆肠压力差显著性下降有关,而与Oddi括约肌的收缩频率、间期及十二指肠压无关.     

电针足三里穴对不完全性肠梗阻大鼠小肠肌电活动的影响

目的:探讨电针足三里穴对肠梗阻大鼠小肠肌电活动的影响.方法:采用非贯穿肠管的方式,末端回肠套环建立不完全性肠梗阻大鼠模型,将大鼠随机分为:空白对照组(n=10)、假手术组(n=10)、肠梗阻组(IO组,n=10)、肠梗阻+电针组(14dIO+EA组,n=10,21dIO+EA组,n=10).造模成功后空白对照组、假手术组、IO组均未给予电针治疗措施,IO+EA组连续给予电针14d、21d电针治疗措施.最后1次电针后2h,分别测体质量后打开腹腔,肉眼观察回肠组织形态学的改变,BL-420F生物机能实验系统测定回肠肌电.结果:IO组大鼠体质量较空白对照组和假手术组显著降低(P<0.01),IO+EA组大鼠体质量较IO组显著升高(P<0.01).回肠肌电慢波活动改变情况:14dIO组振幅(mV)低于空白对照组(0.11±0.03vs0.35±0.06,P<0.01),且频率(%)、振幅(%)变异系数均明显高于空白对照组和假手术组(27.71±10.54vs14.08±4.22,22.00±6.24;75.54±8.59vs15.84±1.49,20.67±7.57,均P<0.01);电针实验治疗IO+EA组大鼠14...     

Motor Pattern of the Sphincter of Oddi in Patients with Bilioenteric Shunt: A Manometric Study

An endoscopic biliary manometry was performed on 11 patients with a surgical bilioenteric shunt--choledochoduodenostomy--and no pressure gradient between common bile duct and duodenum. Basal pressure and frequency of the phasic waves of the sphincter of Oddi were significantly higher in these patients than in controls or in patients with retained common bile duct stones. These results suggest a functional adaptation of the sphincter of Oddi in an attempt to recover the normal pressure in the biliary tract.     

Manometric study of the sphincter of Oddi in patients with and without common bile duct stones

Motor activity of the sphincter of Oddi has been evaluated in 34 patients who underwent ERCP examination. Manometric recordings from the common bile duct and the sphincter of Oddi were performed with a polyethylene triple lumen catheter. At ERCP 16 patients had undamaged biliary ducts; six had undergone cholecystectomy and six had gall bladder stones; 18 patients had common bile duct stones; nine of whom had undergone cholecystectomy, and seven had gall bladder stones. Length and amplitude of the resting sphincter pressure as well as frequency, duration, amplitude, and propagating pattern of phasic contractions did not significantly differ in patients with and without common bile duct stones. Sphincter of Oddi motor activity did not appear to be influenced by the variation in the diameter of the common bile duct or by previous cholecystectomy.     

Endoscopic biliary manometry in patients with suspected sphincter of Oddi dysfunction and in patients with cystic dilatation of the bile ducts

We studied the motility of the sphincter of Oddi in 12 patients with suspected sphincter of Oddi dysfunction, in four patients with cystic dilatation of the bile ducts (two Caroli's cases and two fusiform choledochal cyst cases), and in 33 patients with retained common duct stones. In these last 33 patients, the motor activity of the sphincter of Oddi was similar to that recorded in nine control subjects without pancreatic or biliary diseases. In the suspected Oddi dysfunction cases, both the basal sphincteric pressure and the frequency of the phasic contractions were significantly elevated (P<0.001). Patients with biliary cystic dilatation showed an increased basal pressure, but the frequency of the contractions was elevated in only those with choledochal cysts and the amplitude in only one of the two patients with Caroli's disease. Motor disorders of the sphincter of Oddi provide a basis for an alternative etiopathogenesis of cystic disease of the biliary system and a possible explanation for pain and dilatation of the bile duct in patients with suspected sphincter of Oddi dysfunction.     

Sphincter of Oddi motor activity in patients with stones in gall-bladder, common bile duct or intrahepatic duct and the effect of morphine

Abstract Sphincter of Oddi phasic motor activity and common bile duct pressure were investigated in controls (seven patients) and in patients with gall-bladder stones (five patients), common bile duct stones (15 patients), or intrahepatic stones (13 patients). There were no significant differences in amplitude and frequency of the phasic activity or the common bile duct pressure between the controls and disease groups. Basal pressure of the phasic contraction, however, was significantly lower in patients with common bile duct or intrahepatic stones than in the controls or gall-bladder stone group. The administration of morphine, known to cause spasm of the sphincter of Oddi, increased the basal pressure and frequency of the phasic waves in all groups, while the amplitude remained unchanged. Response to morphine in patients with common bile duct or intrahepatic stones was similar to the controls. However, the basal pressure in these latter groups was lower than in the controls, even after stimulation by morphine. The high incidence of bacterial growth in bile from these patients hitherto reported may be attributable to ascending infection possibly resulting from the low basal pressure of the sphincter of Oddi.     

Common bile duct pressure and Oddi sphincter pressure in patients with common bile duct stones with and without juxta-ampullar diverticula of the duodenum.

Resting common bile duct pressure and Oddi sphincter pressure were measured in 16 patients with common bile duct stones, 8 having in addition a juxta-ampullar diverticulum. Pressure measurements were performed with an infused catheter introduced through an endoscope under direct vision. No significant differences in fasting common bile duct pressures were observed between the two groups. The Oddi sphincter had a phasic activity, and the peak pressure was similar in both groups.     

Percutaneous transhepatic cholangioscopic lithotripsy and change of biliary manometry patterns.

BACKGROUND/AIMS: Percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) is used to remove bile duct stones. This work aims to evaluate the clinical usefulness of PTCSL and the reversibility of the terminal bile duct dysfunctions after PTCSL. METHODOLOGY: Thirty patients who underwent PTCSL using mechanical and/or electrohydraulic lithotripsy over the past 10 years (20 patients with common bile duct stones and 10 with intrahepatic bile duct stones) were evaluated. Terminal bile ductal pressure was measured using the percutaneous transhepatic biliary drainage (PTBD) tube prior to and after lithotripsy by means of variable-load cholangiomanometry. RESULTS: Complete stone extraction was possible in 26 patients (86.7%). The other 4 patients had intrahepatic stones. Complications included 2 cases of hemobilia, one of pneumonia, and 3 of localized peritonitis. Of 26 patients without residual stones, only 4 patients had a linear pressure flow (P-F) pattern which indicates normal biliary tract function prior to lithotripsy. In 17 of 22 patients with other type P-F patterns, however, these types also changed to a linear pattern after complete removal of stones. The P-F pattern of the other 5 patients remained unchanged. CONCLUSIONS: PTCSL is a safe and efficient method treating biliary tract lesions while preserving the function of the sphincter of Oddi. The terminal biliary tract function normalized after stone removal. Thus, PTCSL was useful for patients with complicated bile duct stones not accessible to endoscopic retrograde management.     

Relationship between intraduodenal peri-ampullary diverticulum and biliary disease in 178 patients undergoing ERCP

BACKGROUND:The presence of intraduodenal peri-ampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography(ERCP).A few papers in China and overseas reported that the diverticulum had something to do with the incidence of cholelithiasis. This study was undertaken to further test this notion and ascertain the relationship between intraduodenal peri- ampullary diverticulum and biliary disease,especially the formation of bile duct pigment stones. METHODS:A total of 178 patients who had undergone ERCP or endoscopic sphincterotomy(EST)were studied retrospectively.They were divided into 6 groups according to the category of biliary disease,and the incidence rates of intraduodenal peri-ampullary diverticulum were calculated. RESULTS:There were 44 patients with intraduodenal peri- ampullary diverticulum in 81 patients with primary bile duct pigment stones(54.32%),4 in 8 patients with bile duct stones and gallbladder stones(50%),7 in 33 patients with bile duct stones secondary to gallbladder stones(21.21%), 3 in 21 patients with inflammation and stricture of the end of the bile duct and papilla(14.29%),1 in 22 patients with carcinoma of the end of the bile duct and papilla(4.54%), and 5 in 13 patients with post-cholecystectomy syndrome or sphincter of Oddi dysfunction(38.46%). CONCLUSIONS:The incidence rate of intraduodenal peri- ampullary diverticulum in patients with primary bileduct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones,patients with inflammation and stricture of the end of the bile duct and papilla,and patients with carcinoma of the end of the bile duct and papilla.These findings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones.     

The relationship of bile duct crystals to sphincter of Oddi Dysfunction

Bile duct crystals collected either from the duodenum after gallbladder contraction or directly from bile duct aspiration are surrogates for gallbladder stones and microlithiasis. Whether bile crystals also serve as surrogates for bile duct stones or microlithiasis that forms in the bile duct after cholecystectomy is not known based on current data. Sphincter of Oddi dysfunction (SOD), due either to muscular spasm or sphincter fibrosis, is a cause of bile duct obstruction. Almost all of the literature on SOD involves patients who have had a prior cholecystectomy. Intuitively, obstruction at the SO following cholecystectomy would seem to lead to biliary stasis and predispose patients to bile duct microlithiasis. However, a recent study did not find bile duct crystals in patients with manometrically diagnosed SOD. The reason for this is unknown, although we hypothesize that cholesterol and bilirubinate crystals are not surrogates for brown pigment stones commonly found in patients following cholecystectomy.     

Frequency of biliary crystals in patients with suspected sphincter of Oddi dysfunction

BACKGROUND: The passage of gallstones (macro- or microlithiasis) is theorized to play a role in inducing sphincter of Oddi dysfunction. This study examined the frequency at which biliary crystals are found in patients with suspected type II and type III sphincter of Oddi dysfunction. METHODS: A total of 85 patients (66 women, 19 men; mean age 38 years) with unexplained abdominal pain of suspected pancreatobiliary origin and no prior episode of pancreatitis underwent ERCP with sphincter of Oddi manometry and bile collection for crystal analysis. Eighty-one patients had a gallbladder in situ. No patient had evidence of stones or sludge on prior abdominal imaging. Sphincter of Oddi manometry was performed in standard retrograde fashion by using an aspirating catheter. Patients were classified by sphincter of Oddi dysfunction type by using a modified Hogan-Geenen classification system. Patients with type I sphincter of Oddi dysfunction were excluded. Bile was collected directly from the gallbladder (n=23) or common bile duct (n=62) after an infusion of 3.5 microg of cholecystokinin and was examined by light and polarizing microscopy for cholesterol crystals or calcium bilirubinate granules. RESULTS: The proportion of patients with crystals was 3.5% (3/85). Thirty-five patients (41%) had elevated biliary and/or pancreatic sphincter pressure (type II, 16; type III, 19), of whom one (3%) had cholesterol crystals. Fifty patients had normal sphincter pressure, of whom two (4%) had cholesterol crystals (p=0.6). All 3 patients with cholesterol crystals had a gallbladder in situ. Calcium bilirubinate granules were not found in any patient. CONCLUSIONS: Microlithiasis appears to be rare in patients suspected to have type II or type III sphincter of Oddi dysfunction. Evaluation of bile for crystals appears unproductive in this group of patients.     

Bile duct crystals do not contribute to sphincter of Oddi dysfunction

BACKGROUND: Microlithiasis has been proposed as a cause of both occult gallbladder disease and of idiopathic pancreatitis. Theoretically, microlithiasis could also cause postcholecystectomy pain by causing temporary biliary obstruction and may be more common in patients with sphincter of Oddi dysfunction. The frequency of crystals in bile duct aspirates was assessed from patients with symptoms after cholecystectomy with and without elevated baseline sphincter of Oddi pressures. METHODS: A prospective analysis was performed on all patients with recurrent biliary pain after cholecystectomy who presented for ERCP and manometry between January 1998 and June 2000. All patients had aspirates obtained from the common bile duct for crystal analysis by using the aspirating port of the manometry catheter before the injection of contrast. Four to 20 mL of bile was examined by microscopy for both cholesterol and bilirubinate crystals. RESULTS: Sixty patients (83% women, mean age 44 years) were studied. Thirty-five had normal baseline biliary sphincter pressures and 25 elevated biliary baseline sphincter pressures (>40 mm Hg). Two patients in the normal pressure group and 1 in the elevated pressure group had cholesterol crystals present in their aspirate. No patient had bilirubinate crystals present. A 5% frequency of microlithiasis was identified overall. CONCLUSIONS: Bile duct crystals occur infrequently in patients with symptoms after cholecystectomy and are found in patients with normal and abnormal biliary sphincter manometry. This study suggests that the presence of bile duct crystals, or microlithiasis, does not play a role in sphincter of Oddi dysfunction.