Diagnosis of sphincter of Oddi dysfunction in patients with postcholecystectomy syndrome from hepatobiliary scintigraphic findings

Objective: to diagnose and estimate the clinical value of postcholecystectomy sphincter of Oddi dysfunction in patients.

Material and methods. Examinations were made in 100 postcholecystectomy patients without signs of cholestasis; of them 14 postpapillotomy patients formed a comparison group. Hepatobiliary scintigraphy using the radiotracer 99mTC-bromeside was performed for 90 minutes with cholagogue breakfast at 45 minutes. Common bile duct and duodenal functions and duodenogastric reflux (DGR) were evaluated comparing them with clinical, laboratory, and instrumental findings.

Results. Two patient groups were identified according to bile outflow changes. In Group 1 consisting of 20 (23.2%) patients, the time of maximum accumulation (Tmax) of the radiopharmaceutical in the projection of the choledochus coincided with that in the cholagogue test (46.0±1.8 min) and in Group 2 including 66 (76.8%) patients that was shorter than in the cholagogue test (32.9±6.8 min) (p<0.05). In Group 2, Tmax was similar to that in the comparison group (30.9±7.5 min; р>0.05) and there was no significant difference in intestinal imaging time (18.6±6.0 min versus 17.6±0.8) either, which could be indicative of sphincter of Oddi dysfunction. Diarrhea was observed in 73% of the patients with sphincter of Oddi dysfunction and in 86% of the patients in the comparison group versus 10% of the patients with normal bile passage (p<0.01). Statistical data processing showed a correlation of the indicators of sphincter of Oddi dysfunction with those of duodenal evacuator function (r=0.57; p<0.0005) and DGR (r=0.74; p<0.009).

Conclusion. Postcholecystectomy sphincter of Oddi dysfunction assumes the greatest clinical value in patients with duodenal motor-evacuator dysfunction, which should be kept in mind when choosing a treatment policy.

1. Kovalev A.I., Sokolov A.A., Akkuratova A.Yu. Postcholecystectomy syndrome: causes, tactics of surgical treatment. Novosti khirurgii. 2011; 19 (1): 16–21 (in Russian).

2. Serova E.V. Controversial terminology and classification postcholecystectomy syndrome. Vestnik eksperimental'noy i klinicheskoy khirurgii. 2009; 2 (4): 339–43 (in Russian).

3. Tsimmerman Ya.S., Kunstman T.G. Postcholecystectomy syndrome: a modern view on the problem. Klinicheskaya meditsina. 2006; 8: 4–11 (in Russian).

4. Hogan W.J, Geenen J.E. Biliary dyskinesia. Endoscopy. 1988; 20 (Suppl. 1): 179–83.

5. Kuznetsov N.A., Sokolov A.A., Akkuratova A.Yu., Kasimov A.O., Kurmaev Yu.A., Artemkin E.N. Dynamic hepatobiliary scintigraphy with drug test in the diagnosis of the pathology of a large duodenal papilla. Vestnik Rossiyskogo gosudarstvennogo meditsinskogo universiteta. 2006; 6: 31–5 (in Russian).

6. Behar J., Corazziari E., Guelrud M., Hogan W., Sherman S., Toouli J. Functional gallbladder and sphincter of Оddi disorders. Gastroenterology. 2006; 130: 1498–509.

7. Imler T.D., Sherman S., McHenry L., Fogel E.L., Watkins J.L., Lehman G.A. Low yield of significant findings on endoscopic retrograde cholagiopancreatography in patients with pancreatobiliary pain and no objective findings. Dig. Dis. Sci. 2012; 57 (12): 3252–7.

8. Drossman D.A. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006; 130 (5): 1377–90.

9. Cicala M., Habib F.I., Vavassori P., Pallotta N., Schillaci O., Costamagna et al. Outcome of endoscopic sphincterotomy in post cholecystectomy patients with sphincter of Oddi dysfunction as predicted by manometry and quantitative choledochoscintigraphy. Gut. 2002; 50 (5): 665–8.

10. Craig A.G., Peter D., Saccone G.T.P., Ziesing P., Wycherley A., Toouli J. Scintigraphy versus manometry in patients with suspected biliary sphincter of Oddi dysfunction. Gut. 2003; 52: 352–7.

11. Thomas P.D., Turner J.G., Dobbs B.R., Burt M.J., Chapman B.A. Use of (99m)Tc-DISIDA biliary scanning with morphine provocation for the detection of elevated sphincter of Оddi basal pressure. Gut. 2000; 46: 838–41.

12. Corazziari E., Cicala M., Scopinaro F., Schillaci O., Habib I.F., Pallotta N. Scintigraphic assessment of SO dysfunction. Gut. 2003; 52 (11): 1655–6.

13. Kudryashova N.E., Ermolov A.S., Ivanov P.A., Gulyaev A.A., Samsonov V.T., Trofimova E.Yu. et al. Hepatobiliscintigraphy in the diagnosis of obstructive jaundice. Vestnik rentgenologii i radiologii. 2007; 3: 39–45 (in Russian).

14. Belyaev M.N., Repin M.V., Vagner T.E. Dynamic hepatobiliary scintigraphy in the evaluation of the efficiency of reconstructive surgery in patients after gastrectomy. Vestnik rentgenologii i radiologii. 2007; 2: 34–8 (in Russian).

15. Lishmanov Yu.B., Chernov V.I. (eds). Radionuclide diagnostics for practitioners. Tomsk: SST; 2004 (in Russian).