Researchers from Rome, Italy, assessed the usefulness of choledochoscintigraphy, compared with manometry, in predicting outcome of sphincterotomy in post cholecystectomy patients with sphincter of Oddi dysfunction.
They enrolled 30 patients with biliary-type pain complying with the Rome diagnostic criteria of sphincter of Oddi dysfunction and belonging to biliary Group I and II.
These were subjected to clinical evaluation, choledochoscintigraphic assessment of the hepatic hilum-duodenum transit time, endoscopic retrograde cholangiopancreatography, and perendoscopic manometry.
Some 22 biliary Group I and II patients, with prolonged hepatic hilum-duodenum transit times, were invited to undergo sphincterotomy.
Of these, 14 patients underwent sphincterotomy and 8 refused.
Clinical and scintigraphic assessments were performed at follow up.
|Favorable outcome correctly predicted:|
Hepatic hilum-duodenum transit time was delayed in all patients with manometric evidence of sphincter of Oddi dysfunction, in all biliary Group I patients, and in 64% of biliary Group II patients.
The researchers found that, at follow up, all patients who underwent sphincterotomy were symptom free. In addition, hepatic hilum-duodenum transit time had either normalized or significantly improved.
A favorable post sphincterotomy outcome was predicted in 93% of cases at choledochoscintigraphy and in 57% at manometry.
Dr M. Cicala, of the University of Rome, said on behalf of fellow authors, "Quantitative choledochoscintigraphy is a useful and non-invasive test to diagnose sphincter of Oddi dysfunction."
"It is also a reliable predictor of sphincterotomy outcome in post cholecystectomy biliary Group I and II patients, irrespective of clinical classification and manometric findings," it was concluded.