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May 5, 1951


JAMA. 1951;146(1):38. doi:10.1001/jama.1951.03670010042016

Frequently the pancreatic duct drains into the ampulla of Vater and shares a passageway with the common bile duct into the intestine. In such instances an obstruction at the duodenal orifice could cause pancreatitis by a reflux of bile into the pancreas. In 1919 Archibald1 reported that this situation could be produced by a spasm of the sphincter of Oddi and recommended sphincterotomy as the treatment for chronic pancreatitis. By inducing contraction of this muscle during cholangiographic study of such cases, Doubilet and Mulholland2 have demonstrated a regurgitation of the radiopaque material into the pancreatic duct. When this phenomenon is present, the sphincteral muscle is clipped by a specially designed sphincterotome, which is manipulated through an opening in the common duct. There is danger of the surrounding duodenal musculature being cut with the scalpel if these muscle fibers are incised through a transduodenal exposure of the ampulla. A