Comparision.pdfVIP

Comparison of sphincter of Oddi manometry, fatty meal sonography, and hepatobiliary scintigraphy in the diagnosis of sphincter of Oddi dysfunction Mark L. Rosenblatt, MD, Marc F. Catalano, MD, Eduardo Alcocer, MD, Joseph E. Geenen, MD Milwaukee, Wisconsin Background: Sphincter of Oddi dysfunction (SOD) afflicts approximately 1% to 5% of patients after cholecystectomy. The diagnostic standard for SOD is sphincter of Oddi manometry (SOM), a tech- nically difficult, invasive test that is frequently complicated by pancreatitis. A sensitive and accu- rate noninvasive imaging modality is thus needed for the diagnosis of SOD. Quantitative hepato- biliary scintigraphy (HBS) and fatty meal sonography (EMS) are frequently used for this purpose, but results vary.This study compared SOM, HBS, and EMS in the diagnosis of SOD in a large group of patients. Methods: Three hundred four consecutive patients after cholecystectomy (38 men, 266 women, age 17-72 years) suspected to have SOD were evaluated by SOM, FMS, and HBS. SOM was considered abnormal if any of the following were observed: (1) increased basal pressure (greater than 40 mm Hg), (2) increased phasic activity with amplitude greater than 350 mm Hg, (3) frequency of contrac- tions greater than 8 per minute, (4) greater than 50% of propagation sequences retrograde, and (5) paradoxical response to cholecystokinin. FMS was considered abnormal if ductal dilation was greater than 2 mm at 45 minutes after fatty meal ingestion. Quantitative HBS was performed with sequential images obtained every 5 minutes for 90 minutes to monitor excretion of the radionuclide. Time-to-peak, halftime, and downslope were calculated according to predetermined ranges. Results: A diagnosis of SOD was made in 73 patients (24%) by using SOM as the reference stan- dard. HBS was abnormal in 86 whereas EMS was abnormal in 22 patients. A true-positive result was obtained in 15 patients by EMS and 36 patients with HBS. EMS and HBS gave false-positive results