Scintigraphic sign of functional biliary obstruction is pathognomic for sphincter of Oddi dysfunction.
OBJECTIVE
Quantitative hepatobiliary scintigraphy (QHBS) is a valuable method for the detection of a low-grade biliary obstruction in patients with suspected sphincter of Oddi (SO) dysfunction (SOD), though the relatively low specificity of this noninvasive test has been criticized. The aim of the present study was a critical assessment of the diagnostic value of glyceryl trinitrate-augmented QHBS in patients with suspected SOD.


METHODS
Glyceryl trinitrate-augmented QHBS and endoscopic retrograde cholangiopancreatography (ERCP) was performed on 27 cholecystectomized patients with suspected SOD.


RESULTS
In 14 patients the ERCP depicted organic causes of biliary obstruction (choledocholithasis, juxtapapillary diverticulum, Vater papilla adenoma and common bile duct stenosis). In 12 of the 13 patients with inconclusive ERCP, endoscopic SO manometry demonstrated an elevated SO basal pressure. In patients with manometrically confirmed SOD, glyceryl trinitrate administration significantly increased the radioactive bile transit into the duodenum and normalized the QHBS parameters. In contrast, the 14 patients with an organic biliary obstruction glyceryl trinitrate administration had no effect on the transpapillary bile flow.


CONCLUSIONS
In conclusion, glyceryl trinitrate-augmented QHBS is a specific method in the diagnosis of SOD, proving the functional reversibility of the biliary obstruction.
Bertalan
Viktória
V
First Department of Internal Medicine, University of Szeged, Hungary. bervik@in1st.szote.u-szeged.hu
Madácsy
Lászlo
L
Pávics
Lászlo
L
Lonovics
János
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001657:Biliary Dyskinesia / Q000000981:diagnostic imaging; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003137:Common Bile Duct Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D005996:Nitroglycerin; D011877:Radionuclide Imaging; D009803:Sphincter of Oddi / Q000503:physiopathology*
D005996:Nitroglycerin