ceruletide and Common-Bile-Duct-Diseases

Topics: Ampulla of Vater; Atropine; Ceruletide; Cholangiopancreatography, Endoscopic Retrograde; Common Bile Duct Diseases; Endoscopy; Glucagon; Humans; Manometry; Papaverine; Pressure; Sphincter of Oddi

A nonoperative examination of the function of the sphincter of Oddi, involving percutaneous transhepatic manometry via the percutaneous transhepatic biliary drainage tract, was developed and clinically applied in 23 patients with biliary disease. Long-term recording of sphincter of Oddi motility, which was impossible using conventional intraoperative or endoscopic manometry, was made possible by means of this method and revealed various changes of sphincter of Oddi motility. The mean recording time was 131.33 +/- 9.77 min. The frequency of contractions of the sphincter of Oddi in basal fasting conditions varied from 0 to 13/min and high-frequency contractions (frequency 9.49 +/- 0.35/min, duration 5.77 +/- 0.54 min) were observed in 12 patients on a total of 19 occasions. In five patients, high-frequency contractions were observed twice during one session of continuous recording and the interval between burst contractions was 85.4 +/- 13.3 min. Long-term continuous recording is advantageous for the evaluation of the function of the sphincter of Oddi and short-term manometry may not be representative of overall sphincter of Oddi motility.

Topics: Adult; Aged; Aged, 80 and over; Ceruletide; Cholelithiasis; Common Bile Duct Diseases; Constriction, Pathologic; Dilatation, Pathologic; Eating; Gastrointestinal Motility; Humans; Manometry; Middle Aged; Sphincter of Oddi

Using a percutaneous transhepatic cholangioscopy (PTCS) catheter, sphincter of Oddi motility was measured in a patient with papillary stenosis secondary to bile duct stones. Prior to sphincterotomy, intramuscular injection of 20 micrograms caerulein did not inhibit pathological contraction waves of the sphincter of Oddi or relieve abdominal pain. Endoscopic sphincterotomy of the lower segment of the sphincter of Oddi resulted in recovery of the normal response to caerulein, i.e. relaxation of the sphincter of Oddi. This observation indicates that the pathological contraction and lack of relaxation to cholecystokinin in a patient with papillary stenosis is due to high common bile duct pressure. The measurement of motility of sphincter of Oddi via the PTCS route is useful in diagnosing motor disorders in the sphincter of Oddi and is helpful in deciding to perform endoscopic sphincterotomy.

Topics: Aged; Ampulla of Vater; Ceruletide; Common Bile Duct Diseases; Female; Humans; Manometry; Muscle Contraction; Sphincter of Oddi; Sphincterotomy, Transduodenal

This study reviewed 12 patients with the reflux sign in cholescintigraphy to assess its diagnostic usefulness in evaluating biliary passage. The reflux sign was determined by appearance or increase of the radioactivity in peripheral intrahepatic bile ducts after intramuscular injection of 10 micrograms of ceruletide diethylamine (caerulein). Of the 12 patients, there were common bile duct (CBD) stone in four, chronic pancreatitis in two, biliary dyskinesia in two, papillary adenoma of the CBD, dilated CBD, papillitis, and juxtapapillary duodenal diverticulum in one each. Cholangiographically, dilated caliber of the CBD more than or equal to 12 mm was found in five and equivocal caliber of 8 to 11 mm was in the remaining seven. Apparent stenosis of the CBD was found in four with dilated CBD. There were two patients who had CBD stone with equivocal caliber of the CBD. The reflux sign seems to be a sensitive finding indicating the presence of biliary dysfunction, and would be helpful for the detection of incomplete obstruction of the CBD or CBD stone, especially in a patient with equivocal caliber of the CBD.

Topics: Adult; Aged; Bile Reflux; Biliary Tract; Biliary Tract Diseases; Ceruletide; Cholangiography; Cholestasis; Common Bile Duct; Common Bile Duct Diseases; Female; Gallbladder; Humans; Male; Middle Aged; Muscle Contraction; Radionuclide Imaging; Retrospective Studies

Topics: Adult; Aged; Ampulla of Vater; Ceruletide; Common Bile Duct Diseases; Constriction, Pathologic; Diagnosis, Differential; Female; Humans; Intraoperative Period; Male; Middle Aged; Spasm; Sphincter of Oddi