Correlation Between Sphincter of Oddi Manometry and Intraductal Ultrasound Morphology in Patients with Suspected Sphincter of Oddi Dysfunction

Background and Study Aims: Intraductal ultrasonography (IDUS) makes it possible to study sphincter of Oddi morphology during endoscopy. Two recent IDUS studies have described the sphincter of Oddi as a circumferential hypoechoic layer in the papilla, but there have as yet been few published data from patients with suspected sphincter of Oddi pathology.

Patients and Methods: Twenty-one consecutive patients with suspected biliary sphincter of Oddi dysfunction (seven men, 14 women; age 54 ± 17 years) were enrolled in the study. Endoscopic sphincter of Oddi manometry was carried out using a 4-Fr electronic microtransducer device. After this, a wire-guided 6-Fr ultrasound catheter was placed in the common bile duct (CBD), and IDUS was carried out while the ultrasound catheter was being withdrawn from the CBD toward the duodenum.

Results: Sphincter of Oddi manometry and IDUS were carried out successfully in 18 of the 21 patients. Sphincter of Oddi manometry revealed sphincter of Oddi hypertension (baseline pressure > 35 mmHg) in eight patients. The mean sphincter of Oddi baseline pressure was 32 ± 17 mmHg, and the mean phasic sphincter of Oddi pressure was 132 ± 31 mmHg. During IDUS, a circumferential hypoechoic layer was clearly delineated in all patients. There was a significant correlation between the manometrically determined length of the sphincter of Oddi (8 ± 2 mm) and the thickness of the hypoechoic layer (6 ± 2 mm) as assessed by IDUS (r = 0.66, P < 0.001). However, no correlation was found between the baseline or phasic sphincter of Oddi pressures and the thickness of the hypoechoic layer. Accordingly, IDUS did not allow identification of patients with sphincter of Oddi hypertension. Mild pancreatitis was observed in one of the 18 patients (6 %).

Conclusions: The circumferential hypoechoic layer of the papilla visualized by IDUS is the ultrasonographic correlate of the sphincter of Oddi. IDUS of the papilla is technically feasible and safe in patients with suspected sphincter of Oddi dysfunction. IDUS may provide additional information at the sphincter of Oddi level, but cannot be used as a substitute for sphincter of Oddi manometry.

References

• 1 Yasuda K, Mukai H, Nakajima M, Kawai K. Clinical application of ultrasonic probes in the biliary and pancreatic duct.  Endoscopy. 1992;  24 370-375
• 2 Itoh A, Tsukamoto Y, Naitoh Y, et al. Intraductal ultrasonography for the examination of duodenal papillary region.  J Ultrasound Med. 1994;  13 679-684
• 3 Hogan W J, Geenen J E. Biliary dyskinesia.  Endoscopy. 1988;  20 179-183
• 4 Wehrmann T, Kokabpick S, Lembcke B, et al. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study.  Gastrointest Endosc. 1999;  49 677-683
• 5 Schmitt T, Seifert H, Dietrich C F, et al. Intravenous sedation with propofol during endoscopic sphincter of Oddi manometry.  Z Gastroenterol. 1999;  37 219-227
• 6 Wehrmann T, Schmitt T, Schoenfeld A, et al. Endoscopic sphincter of Oddi manometry with a portable electronic microtransducer system: comparison with the perfusion manometry method and routine clinical application.  Endoscopy. 2000;  32 444-451
• 7 Habib F I, Corraziari E, Biliotti D, et al. Manometric measurement of human sphincter of Oddi length.  Gut. 1988;  29 121-125
• 8 Wehrmann T, Wiemer K, Lembcke B, Jung M. Effect of endoscopic sphincterotomy on sphincter of Oddi manometry results in patients with or without papillary stenosis.  Z Gastroenterol. 1995;  33 662-668
• 9 Menzel J, Domschke W. Gastrointestinal miniprobe sonography: the current status.  Am J Gastroenterol. 2000;  95 605-616
• 10 Menzel J, Poremba C, Dietl K H, Domschke W. Preoperative diagnosis of bile duct strictures: comparison of intraductal ultrasonography with conventional endosonography.  Scand J Gastroenterol. 2000;  35 77-82
• 11 Tamada K, Wada S, Ohashi A, et al. Intraductal US in assessing the effects of radiation therapy and predicting of patency of metallic stents in extrahepatic bile duct carcinoma.  Gastrointest Endosc. 2000;  51 405-411
• 12 Menzel J, Hoepffner N, Sulkowski U, et al. Polypoid tumors of the major duodenal papilla: comparison of preoperative staging with intraductal US, EUS, and CT - a prospective, histopathologically controlled study.  Gastrointest Endosc. 1999;  49 349-357
• 13 Ohashi A, Ueno N, Tamada K, et al. Assessment of residual bile duct stones with use of intraductal US during endoscopic balloon sphincteroplasty: comparison with balloon cholangiography.  Gastrointest Endosc. 1999;  49 328-333
• 14 Tamada K, Tomiyama T, Oohashi A, et al. Bile duct wall thickness measured by intraductal US in patients who have not undergone previous biliary drainage.  Gastrointest Endosc. 1999;  48 199-203
• 15 Tamada K, Tomiyama T, Ichiyama M, et al. Influence of biliary drainage catheter on bile duct wall thickness as measured by intraductal ultrasonography.  Gastrointest Endosc. 1998;  47 28-32
• 16 Tamada K, Ueno N, Tomiyama T, et al. Characterization of biliary strictures using intraductal ultrasonography: comparison with percutaneous cholangioscopic biopsy.  Gastrointest Endosc. 1998;  47 341-349
• 17 Menzel J, Domschke W, Konturek J W, et al. Intraduktaler Ultraschall im pankreatobiliären System.  Dtsch Med Wochenschr. 1997;  122 41-50
• 18 Furukawa T, Oohashi K, Yamao K, et al. Intraductal ultrasonography of the pancreas: development and clinical potential.  Endoscopy. 1997;  29 561-569
• 19 Itoh A, Goto H, Naitoh Y, et al. Intraductal ultrasonography in diagnosing tumor extension of cancer of the papilla of Vater.  Gastrointest Endosc. 1997;  45 251-260
• 20 Ueno N, Nishizono T, Tamada K, et al. Diagnosing extrahepatic bile duct stones using intraductal ultrasonography: a case series.  Endoscopy. 1997;  29 356-360
• 21 Chak A, Isenberg G, Kobayashi K, et al. Prospective evaluation of an over-the-wire catheter US probe.  Gastrointest Endosc. 2000;  51 202-205
• 22 Wong R F, Bonapace E S, Chung C Y, et al. Simultaneous endoluminal ultrasonography and manometry to assess anal sphincter complex in normal subjects.  Dig Dis Sci. 1998;  43 2363-2372
• 23 Fukuta R, Iwai N, Yanagikara J, et al. A comparison of anal EUS with electromyography and manometry in high and intermediate anorectal anomalies.  J Pediatr Surg. 1997;  32 839-842
• 24 Schäfer R, Heyer R, Gantke B, et al. Anal endosonography and manometry: comparison in patients with defecation problems.  Dis Colon Rectum. 1997;  40 293-297
• 25 Gress F, Sherman S, Ikenberry S, Lehman G. Can catheter-based endoscopic ultrasound probes predict sphincter of Oddi dysfunction? (abstract).  Gastrointest Endosc. 1996;  43 421