Open AccessManometric Diagnosis of Sphincter of Oddi Spasm as a Cause of Postcholecystectomy Pain and the Treatment by Endoscopic Sphincterotomy
Author(s) -
Masao Tanaka,
Seiyo Ikeda,
Shinji Matsumoto,
Hideo Yoshimoto,
Fumio Nakayama
Publication year - 1985
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-198512000-00009
Subject(s) - medicine , sphincter of oddi , sphincter , cholecystectomy , sphincter of oddi dysfunction , anesthesia , general surgery , surgery
Seventeen patients with postcholecystectomy pain and nine controls were studied by nonoperative biliary manometry with stimulation of sphincter of Oddi spasm by morphine. The controls remained asymptomatic despite an elevation of bile duct pressure after morphine. In 13 patients with postcholecystectomy pain, morphine induced pain paralleling a pressure rise. Three other patients had pain not paralleling a pressure change, and another showed a pressure rise without pain. None of the controls, four with the parallel pain-pressure change, and one with the discordant pain-pressure correlation were positive at the traditional morphine-Prostigmin test. Endoscopic sphincterotomy provided complete (8), moderate (3), or slight (1) relief of pain to 12 patients with the parallel pain-pressure relationship. Postsphincterotomy manometry showed disappearance of both the pressure elevation and pain induction, and the morphine-Prostigmin test turned negative. It is concluded that morphine-induced bile duct pressure elevation coinciding with pain is diagnostic of sphincter spasm as a cause of postcholecystectomy pain, the morphine-Prostigmin test, although helpful, is less specific and less sensitive in diagnosing sphincter spasm than the manometry, and endoscopic sphincterotomy relieves the pain due to this condition in most cases.