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Article
August 1994

Does Endoscopic Sphincterotomy Destroy the Function of Oddi's Sphincter?

Author Affiliations

From the Department of Surgery and the Ludwig-Boltzmann-Institute for Experimental and Gastroenterological Surgery, Salzburg (Austria) General Hospital.

Arch Surg. 1994;129(8):876-880. doi:10.1001/archsurg.1994.01420320102020
Abstract

Objective:  To evaluate the possible destruction of Oddi's sphincter by endoscopic sphincterotomy (ES).

Design:  Prospective, nonrandomized control trial. The study was done from the beginning of 1986 to the end of 1991.

Setting:  The Department of Surgery, Salzburg (Austria) General Hospital.

Patients:  Ninety-one patients with cholecystolithiasis and concomitant different diseases of the common bile duct. Ninety-five patients exclusively having cholecystolithiasis served as the control group.

Interventions:  Patients with cholecystolithiasis plus concomitant different diseases of the common bile duct underwent preoperative ES and, at a second intervention, conventional cholecystectomy. Patients with cholecystolithiasis only underwent elective conventional cholecystectomy.

Main Outcome Measures:  During the cholecystectomy, three pressure and flow variables were routinely measured in the common bile duct: the natural resting pressure, the maximum pressure after the standardized injection of physiologic saline solution, and the normalizing time (the time required for the reappearance of the initial resting pressure).

Results:  The statistical comparison of the two groups showed no significant deviations regarding the resting pressure (P<.4), whereas the maximum pressure was significantly lower (P<.01) in the group that underwent ES. The normalizing time of patients who underwent ES was not statistically different (P<.375) from that of the control group patients.

Conclusion:  The function of Oddi's sphincter is changed but not destroyed following ES.(Arch Surg. 1994;129:876-880)

References
1.
Classen M, Demling L. EPT: 10 years on. Stuttgart, Germany: Georg Thieme Verlag; 1983.
2.
Safrany L.  Transduodenal endoscopic sphincterotomy and extraction of bile duct stones . World J Surg . 1978;2:457-464.Article
3.
Neoptolemos JP, London N, Slater ND, Carr-Locke DL, Fossard DP, Moosa AR.  A prospective study of ERCP and endoscopic sphincterotomy in the diagnosis and treatment of gallstone acute pancreatitis: a rational and safe approach to the management . Arch Surg . 1986;121:697-702.Article
4.
Leung YWC, Chung SCS, Mok SD, Li AKC.  The role of early ERCP and sphincterotomy in the management of acute biliary pancreatitis . Gastroenterology . 1987;90:1503.
5.
Mee AS, Vallon AG, Croker JR, Cotton BP.  Non-operative removal of bile duct stones by duodenoscopic sphincterotomy in the elderly . BMJ . 1981;283:521-523.Article
6.
Cotton PB, Vallon AG.  Duodenoscopic sphincterotomy for removal of bile duct stones in patients with gallbladders . Surgery . 1982;91:628-630.
7.
Siegel JH, Safrany L, Ben-Zvi JS, et al.  Duodenoscopic sphincterotomy in patients with gallbladders in situ: report of a series of 1272 patients . Am J Gastroenterol . 1988;1:1255-1258.
8.
Dresemann G, Kantz G, Bünte H.  Langzeitergebnisse nach endoskopischer Sphinkterotomie bei Patienten mit Gallenblasen in situ . Dtsch Med Wochenschr . 1988; 13:500-505.Article
9.
Miller BM, Kozarek RA, Ryan JA, Ball TJ, Traverso WL.  Surgical versus endoscopic management of common bile duct stones . Ann Surg . 1987;207:135-141.Article
10.
Neoptolemos JP, Carr-Locke DL, Fossard DP.  Prospective randomised study of pre-operative endoscopic sphincterotomy versus surgery alone for common bile duct stones . BMJ . 1987;294:470-474.Article
11.
Worthley CS, Watts JM, Toouli J.  Common duct exploration or endoscopic sphincterotomy for choledocholithiasis? Aust N Z J Surg . 1989;59:209-215.Article
12.
Dubois F, Berthelot G, Levard H.  Cholecystectomie par coelioscopie . Presse Med . 1989;18:980-982.
13.
Reddick EJ, Olsen D.  Laparoscopic laser cholecystectomy . Surg Endosc . 1989; 3:131-133.Article
14.
Semm K. Operative Manual for Endoscopic Abdominal Surgery Year Book . Chicago, Ill: Medical Publishers Inc; 1986.
15.
Böhmig HJ, Fritsch A, Garbsch H.  Funktionelle Resultate nach totaler Sphinkterotomie . Langenbecks Arch Klin Chir . 1965;312:168-186.
16.
Classen M, Demling L.  Endoskopische Sphinkterotomie der Papilla Vateri und Steinextraktion aus dem Ductus choledochus . Dtsch Med Wochenschr . 1974; 99:496-497.Article
17.
Kawai K, Akasaka Y, Murakami M.  Endoscopic sphincterotomy of the ampulla of Vater . Gastrointest Endosc . 1974;2:148-153.Article
18.
Demling L, Seuberth K, Riemann JF.  A mechanical lithotripter . Endoscopy . 1982; 14:100-101.Article
19.
Oselladore D, Rossoni R, Stevanato G.  A percussion lithotripter . Endoscopy . 1986;18:235-237.Article
20.
Boeckl O, Pimpl W, Waldner B, Heinerman PM.  Intraoperative manometry: a useful tool in biliary surgery? Eur Surg Res . 1986;18:169-176.Article
21.
Boeckl O, Hell E.  Intraoperative Gallenwegsdiagnostik mit Radio-Elekto-Manometrie . Dtsch Med Wochenschr . 1977;92:708-715.
22.
Pitt HA.  Is endoscopic sphincterotomy a safe and effective method for management of stones in the distal bile duct?  In: Gitnick Churchill G, ed. Negative Controversies in Gastroenterology . New York, NY: E & S Livingstone; 1984.
23.
Heinerman PM, Boeckl O, Pimpl W.  Selective ERCP and preoperative stone removal in bile duct surgery . Ann Surg . 1989;209:267-272.Article
24.
Langer B.  Identification and treatment of common bile duct stones before cholecystectomy . In: Bengmark S, ed. Progress in Surgery of the Liver , Pancreas, and Biliary System. Dordrecht, the Netherlands: Martinus Nijhoff Publishers; 1988.
25.
Boeckl O.  Rationale for primary operations on the papilla of Vater . Eur Surg Res . 1976;8:400-410.Article
26.
Geenen JE, Toouli J, Hogan WJ, et al.  Endoscopic sphincterotomy: follow-up evaluation of effects on the sphincter of Oddi . Gastroenterology . 1984;87:754-758.
27.
Gregg IA, Carr-Locke DL.  Endoscopic pancreatic and biliary manometry in pancreatic, biliary and papillary disease and after endoscopic sphincterotomy and surgical sphincteroplasty . Gut . 1984;25:1247-1254.Article
28.
Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Venu RP.  The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction . N Engl J Med . 1989;320:82-87.Article
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