Frequency of biliary crystals in patients with suspected sphincter of Oddi dysfunction

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: The passage of gallstones (macro- or microlithiasis) is theorized to play a role in inducing sphincter of Oddi dysfunction. This study examined the frequency at which biliary crystals are found in patients with suspected type II and type III sphincter of Oddi dysfunction. Methods: A total of 85 patients (66 women, 19 men; mean age 38 years) with unexplained abdominal pain of suspected pancreatobiliary origin and no prior episode of pancreatitis underwent ERCP with sphincter of Oddi manometry and bile collection for crystal analysis. Eighty-one patients had a gallbladder in situ. No patient had evidence of stones or sludge on prior abdominal imaging. Sphincter of Oddi manometry was performed in standard retrograde fashion by using an aspirating catheter. Patients were classified by sphincter of Oddi dysfunction type by using a modified Hogan-Geenen classification system. Patients with type I sphincter of Oddi dysfunction were excluded. Bile was collected directly from the gallbladder (n = 23) or common bile duct (n = 62) after an infusion of 3.5 μg of cholecystokinin and was examined by light and polarizing microscopy for cholesterol crystals or calcium bilirubinate granules. Results: The proportion of patients with crystals was 3.5% (3/85). Thirty-five patients (41%) had elevated biliary and/or pancreatic sphincter pressure (type II, 16; type III, 19), of whom one (3%) had cholesterol crystals. Fifty patients had normal sphincter pressure, of whom two (4%) had cholesterol crystals (p = 0.6). All 3 patients with cholesterol crystals had a gallbladder in situ. Calcium bilirubinate granules were not found in any patient. Conclusions: Microlithiasis appears to be rare in patients suspected to have type II or type III sphincter of Oddi dysfunction. Evaluation of bile for crystals appears unproductive in this group of patients.

Original languageEnglish
Pages (from-to)875-878
Number of pages4
JournalGastrointestinal Endoscopy
Volume58
Issue number6
DOIs
StatePublished - Dec 2003

Fingerprint

Sphincter of Oddi Dysfunction
Gallbladder
Cholesterol
Bile
Sphincter of Oddi
Manometry
Bilirubin
Pressure
Endoscopic Retrograde Cholangiopancreatography
Cholecystokinin
Common Bile Duct
Gallstones
Sewage

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Frequency of biliary crystals in patients with suspected sphincter of Oddi dysfunction. / Rashdan, Abdullah; Fogel, Evan; McHenry, Lee; Lehman, Glen; Sherman, Stuart.

In: Gastrointestinal Endoscopy, Vol. 58, No. 6, 12.2003, p. 875-878.

Research output: Contribution to journalArticle

@article{529cfc97cb094686adbdb4fad54651bc,
title = "Frequency of biliary crystals in patients with suspected sphincter of Oddi dysfunction",
abstract = "Background: The passage of gallstones (macro- or microlithiasis) is theorized to play a role in inducing sphincter of Oddi dysfunction. This study examined the frequency at which biliary crystals are found in patients with suspected type II and type III sphincter of Oddi dysfunction. Methods: A total of 85 patients (66 women, 19 men; mean age 38 years) with unexplained abdominal pain of suspected pancreatobiliary origin and no prior episode of pancreatitis underwent ERCP with sphincter of Oddi manometry and bile collection for crystal analysis. Eighty-one patients had a gallbladder in situ. No patient had evidence of stones or sludge on prior abdominal imaging. Sphincter of Oddi manometry was performed in standard retrograde fashion by using an aspirating catheter. Patients were classified by sphincter of Oddi dysfunction type by using a modified Hogan-Geenen classification system. Patients with type I sphincter of Oddi dysfunction were excluded. Bile was collected directly from the gallbladder (n = 23) or common bile duct (n = 62) after an infusion of 3.5 μg of cholecystokinin and was examined by light and polarizing microscopy for cholesterol crystals or calcium bilirubinate granules. Results: The proportion of patients with crystals was 3.5{\%} (3/85). Thirty-five patients (41{\%}) had elevated biliary and/or pancreatic sphincter pressure (type II, 16; type III, 19), of whom one (3{\%}) had cholesterol crystals. Fifty patients had normal sphincter pressure, of whom two (4{\%}) had cholesterol crystals (p = 0.6). All 3 patients with cholesterol crystals had a gallbladder in situ. Calcium bilirubinate granules were not found in any patient. Conclusions: Microlithiasis appears to be rare in patients suspected to have type II or type III sphincter of Oddi dysfunction. Evaluation of bile for crystals appears unproductive in this group of patients.",
author = "Abdullah Rashdan and Evan Fogel and Lee McHenry and Glen Lehman and Stuart Sherman",
year = "2003",
month = "12",
doi = "10.1016/S0016-5107(03)02311-3",
language = "English",
volume = "58",
pages = "875--878",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Frequency of biliary crystals in patients with suspected sphincter of Oddi dysfunction

AU - Rashdan, Abdullah

AU - Fogel, Evan

AU - McHenry, Lee

AU - Lehman, Glen

AU - Sherman, Stuart

PY - 2003/12

Y1 - 2003/12

N2 - Background: The passage of gallstones (macro- or microlithiasis) is theorized to play a role in inducing sphincter of Oddi dysfunction. This study examined the frequency at which biliary crystals are found in patients with suspected type II and type III sphincter of Oddi dysfunction. Methods: A total of 85 patients (66 women, 19 men; mean age 38 years) with unexplained abdominal pain of suspected pancreatobiliary origin and no prior episode of pancreatitis underwent ERCP with sphincter of Oddi manometry and bile collection for crystal analysis. Eighty-one patients had a gallbladder in situ. No patient had evidence of stones or sludge on prior abdominal imaging. Sphincter of Oddi manometry was performed in standard retrograde fashion by using an aspirating catheter. Patients were classified by sphincter of Oddi dysfunction type by using a modified Hogan-Geenen classification system. Patients with type I sphincter of Oddi dysfunction were excluded. Bile was collected directly from the gallbladder (n = 23) or common bile duct (n = 62) after an infusion of 3.5 μg of cholecystokinin and was examined by light and polarizing microscopy for cholesterol crystals or calcium bilirubinate granules. Results: The proportion of patients with crystals was 3.5% (3/85). Thirty-five patients (41%) had elevated biliary and/or pancreatic sphincter pressure (type II, 16; type III, 19), of whom one (3%) had cholesterol crystals. Fifty patients had normal sphincter pressure, of whom two (4%) had cholesterol crystals (p = 0.6). All 3 patients with cholesterol crystals had a gallbladder in situ. Calcium bilirubinate granules were not found in any patient. Conclusions: Microlithiasis appears to be rare in patients suspected to have type II or type III sphincter of Oddi dysfunction. Evaluation of bile for crystals appears unproductive in this group of patients.

AB - Background: The passage of gallstones (macro- or microlithiasis) is theorized to play a role in inducing sphincter of Oddi dysfunction. This study examined the frequency at which biliary crystals are found in patients with suspected type II and type III sphincter of Oddi dysfunction. Methods: A total of 85 patients (66 women, 19 men; mean age 38 years) with unexplained abdominal pain of suspected pancreatobiliary origin and no prior episode of pancreatitis underwent ERCP with sphincter of Oddi manometry and bile collection for crystal analysis. Eighty-one patients had a gallbladder in situ. No patient had evidence of stones or sludge on prior abdominal imaging. Sphincter of Oddi manometry was performed in standard retrograde fashion by using an aspirating catheter. Patients were classified by sphincter of Oddi dysfunction type by using a modified Hogan-Geenen classification system. Patients with type I sphincter of Oddi dysfunction were excluded. Bile was collected directly from the gallbladder (n = 23) or common bile duct (n = 62) after an infusion of 3.5 μg of cholecystokinin and was examined by light and polarizing microscopy for cholesterol crystals or calcium bilirubinate granules. Results: The proportion of patients with crystals was 3.5% (3/85). Thirty-five patients (41%) had elevated biliary and/or pancreatic sphincter pressure (type II, 16; type III, 19), of whom one (3%) had cholesterol crystals. Fifty patients had normal sphincter pressure, of whom two (4%) had cholesterol crystals (p = 0.6). All 3 patients with cholesterol crystals had a gallbladder in situ. Calcium bilirubinate granules were not found in any patient. Conclusions: Microlithiasis appears to be rare in patients suspected to have type II or type III sphincter of Oddi dysfunction. Evaluation of bile for crystals appears unproductive in this group of patients.

UR - http://www.scopus.com/inward/record.url?scp=0346874495&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0346874495&partnerID=8YFLogxK

U2 - 10.1016/S0016-5107(03)02311-3

DO - 10.1016/S0016-5107(03)02311-3

M3 - Article

C2 - 14652556

AN - SCOPUS:0346874495

VL - 58

SP - 875

EP - 878

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 6

ER -