Seiyo Ikeda

Nonoperative measurement of pancreatic and common bile duct pressures with a microtransducer catheter and effects of duodenoscopic sphincterotomy.

Duodenoscopic manometry of the pancreatic duct (PD_ and common bile duct (CBD) using a microtransducer catheter has distinct advantages over infusion manometry, giving absolute values ofin situ intraluminal pressure. Microtransducer manometry was performed without medication in 49 patients with gallbladder stones (10), common bile duct stones (24), hepatic duct stones (6) and common bile duct dilatation (9), and was successful in 42 (86%) for PD and 36 (73%) for CBD. Ductal pressures showed respiration-synchronized biphasic variations superimposed by the arterial pulsation effect. Considerable postural change of the pressure values suggested that the recording posture should be predetermined. The PD-to-duodenum pressure gradient was higher than the CBD-to-duodenum gradient in most cases. Both were lower than those obtained previously by infusion methods. No significant differences were found in pressure profiles of the four disease groups. Endoscopic sphincterotomy significantly reduced not only CBD pressure but also PD pressure.

Continuous measurement of common bile duct pressure with an indwelling microtransducer catheter introduced by duodenoscopy: new diagnostic aid for postcholecystectomy dyskinesia—a preliminary report

Morphine was given to two patients suspected of having postcholecystectomy dyskinesia to induce spasm of sphincter of Oddi and was successful in reproducing pain, while common bile duct pressure was continuously monitored with an indwelling high fidelity microtransducer catheter introduced by duodenoscopy. The rise of intracholedochal pressure was found to coincide exactly with the occurrence of the pain, thus suggesting the biliary origin of the symptom. The common bile duct pressure started to rise immediately after the injection of morphine, and the pressure waves initially showing biphasic variation of respiratory origin became irregular in shape and height, probably reflecting the spasm of the sphincter; these changes were well related to the intensity of the pain. Endoscopic sphincterotomy gave complete relief. A repeat morphine-induced pressure study after the sphincterotomy confirmed the disappearance of both the pain and the irregular waves.

Parapapillary choledochoduodenal fistula: an analysis of 83 consecutive patients diagnosed at ERCP

Eighty-three patients with parapapillary choledochoduodenal fistula diagnosed at endoscopic retrograde cholangiopancreatography over a 10-year period were reviewed. Three cases were associated with carcinoma of the papilla; the remaining 80 (37 female, 43 male) had gallstones. Thirty-one patients had choledocholithiasis, 12 had gallbladder stones, and 14 had intrahepatic stones. Fifty-five patients (69%) had a history of jaundice, whereas 23 (29%) had never experienced jaundice.

Sphincter of Oddi motor activity in patients with stones in gall‐bladder, common bile duct or intrahepatic duct and the effect of morphine

Abstract Sphincter of Oddi phasic motor activity and common bile duct pressure were investigated in controls (seven patients) and in patients with gall‐bladder stones (five patients), common bile duct stones (15 patients), or intrahepatic stones (13 patients). There were no significant differences in amplitude and frequency of the phasic activity or the common bile duct pressure between the controls and disease groups. Basal pressure of the phasic contraction, however, was significantly lower in patients with common bile duct or intrahepatic stones than in the controls or gall‐bladder stone group. The administration of morphine, known to cause spasm of the sphincter of Oddi, increased the basal pressure and frequency of the phasic waves in all groups, while the amplitude remained unchanged. Response to morphine in patients with common bile duct or intrahepatic stones was similar to the controls. However, the basal pressure in these latter groups was lower than in the controls, even after stimulation by morphine. The high incidence of bacterial growth in bile from these patients hitherto reported may be attributable to ascending infection possibly resulting from the low basal pressure of the sphincter of Oddi.

Cholecystobronchial fistula with report of a case

SummaryA case of direct cholecystobronchial fistula was presented. It must be the second case of the disease reported in literatures and the first case diagnosed by means of endoscopic cholangiography. The present case was probably caused by gallbladder penetration with a gallstone after inflammatory adhesions occurring between the gallbladder and the diaphragm as well as the diaphragm and the lung. A radical operation was performed with a complete recovery. The etiology, diagnosis and treatment of the biliobronchial fistula were discussed.A case of direct cholecystobronchial fistula was presented. It must be the second case of the disease reported in literatures and the first case diagnosed by means of endoscopic cholangiography. The present case was probably caused by gallbladder penetration with a gallstone after inflammatory adhesions occurring between the gallbladder and the diaphragm as well as the diaphragm and the lung. A radical operation was performed with a complete recovery. The etiology, diagnosis and treatment of the biliobronchial fistula were discussed.