Background and Study Aims: Endoscopic sphincter of Oddi manometry (ESOM) allows direct
assessment of motor function in the sphincter of Oddi. However, variations in examination
conditions and duodenal motility may have a critical effect on the results of ESOM.
The aim of the present study was to develop a new method - sphincter of Oddi video
manometry - based on simultaneous ESOM and real-time endoscopic image analysis, and
to investigate the usefulness of video manometry for detecting manometric artefacts
during ESOM.
Patients and Methods: Seven consecutive patients who had undergone cholecystectomy
and were referred with a suspicion of sphincter of Oddi dysfunction were investigated.
Sphincter of Oddi pressure and endoscopic images (20 frames/s) were recorded simultaneously
on a Synectics PC Polygraf computer system with a time-correlated basis, and then
compared.
Results: On ESOM, 69 sphincter of Oddi phasic contractions were identified, with an
average amplitude of 153.9 ± 85.0 mmHg and a duration of 7.9 ± 1.2 seconds. Visual
analysis of the real-time endoscopic images, replayed in cine loop by the computer,
revealed 236 separate duodenal contractions, with an average frequency of 3.5 ± 2.4/min
(range: 1 - 12/min). On the ESOM tracing, 78 % of the duodenal contractions had a
corresponding pressure wave with an average duration of 2.8 ± 0.4 seconds and an amplitude
of 71.9 ± 16.7 mmHg. Other artefacts on the ESOM tracings, such as catheter movements,
pseudocontractions, hyperventilation, or retching, were also easily recognized using
simultaneous ESOM and real-time endoscopic image analysis.
Conclusions: Video manometry of the sphincter of Oddi is a promising new method for
improving the analysis and documentation of ESOM tracings. It has several advantages
over the conventional technique, allowing visual detection of duodenal activity and
enabling enhanced recognition of other manometric artefacts.
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M.D. L. Madácsy
First Dept. of Internal Medicine Albert Szent-Györgyi Medical University
Korányi fs. 8, P.O. Box 469
6725 Szeged, Hungary
Telefon: +36-62-455185
eMail: madl@in1st.szote.u-szeged.hu