Motility of Oddi's sphincter: recent developments and clinical applications.
BACKGROUND
In recent years, applications of electromyographic, cineradiographic, scintilographic, and endoscopic manometric techniques have improved our knowledge of normal and abnormal motility of Oddi's sphincter. This sphincter coordinates the time and rate of secretion of about 3 liters of bile and pancreatic juice into the duodenum daily.


METHODS
Oddi's sphincter may be evaluated by endoscopic manometry, ultrasound, dynamic hepatobiliary scintigraphy, and laboratory tests. Endoscopic manometry is the best method for evaluating the function Oddi's sphincter.


RESULTS
The basal pressure of Oddi's sphincter is usually 5 to 15 mm Hg greater than the bile and pancreatic duct pressures. Phasic contractions of 50 to 150 mm Hg in amplitude and 3 to 8 contractions per minute in frequency are superimposed on the basal pressure. A small percentage of patients with gastrointestinal symptoms after cholecystectomy has sphincter of Oddi dysfunction, which may have structural abnormality (papillary stenosis) or functional abnormality (Oddi's sphincter dyskinesia).


CONCLUSIONS
Elevated basal pressure ( > 40 mm Hg) is the most important manometric finding of Oddi's sphincter dysfunction. Endoscopic sphincterotomy is the treatment of choice for patients with Oddi's sphincter dysfunction and elevated basal sphincter pressure.
Coelho
J C
JC
Department of Surgery, Federal University of Parana, Curitiba, Brazil.
Wiederkehr
J C
JC
D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000503:physiopathology; D003952:Diagnostic Imaging; D006801:Humans; D009068:Movement; D011312:Pressure; D009803:Sphincter of Oddi / Q000502:physiology* / Q000503:physiopathology; D016717:Sphincterotomy, Endoscopic