Sphincter of Oddi (SO) manometry is at present the "gold standard" investigation for patients with suspected biliary SO dysfunction.
However, non-invasive scintigraphy in cholecystectomised patients, using a scoring system, or the transit time from the hepatic hilum to the duodenum (HDTT), has been suggested as an alternative.
In this study, researchers evaluated the scintigraphic scoring system and HDTT in patients with suspected biliary SO dysfunction undergoing SO manometry.
Their findings are published in the March issue of Gut.
The research team prospectively studied cholecystectomised patients undergoing SO manometry for persistent biliary-type pain.
They performed scintigraphy with cholecystokinin octapeptide infusion within a month prior to manometry.
| Scintigraphic scoring had a sensitivity of 25 to 38%.|
The scoring of the scans, and measurement of HDTT was performed by independent blinded observers.
Manometry of the biliary sphincter was performed per-endoscopically. It was defined as abnormal if basal pressure was ≥40 mm Hg.
Overall, 32 patients were enrolled in the study, 30 were female, with a mean age of 45.1 years.
The team excluded 3 of the 33 patients as manometry from the bile duct was not technically possible.
The researchers found that 8 patients had abnormal manometry.
However, scintigraphic scoring had a sensitivity of 25 to 38%, a specificity of 86 to 89%, positive predictive value (PPV) of 40 to 60%, and a negative predictive value (NPV) of 75 to 79%.
Furthermore, HDTT sensitivity was 13%, specificity 95%, PPV 50%, and NPV 74%.
Dr Craig’s team concluded, “Our findings indicate that scintigraphy using these methods of analysis correlates poorly with manometry in post cholecystectomy patients with suspected biliary SO dysfunction”.