Passage of ductal stones (macro or microlithiasis) is theorized to play a role in inducing SOD. This is especially controversial in Type II and Type in SOD patients. This study was undertaken to determine the frequency of cholesterol crystals (CC) and calcium bilirubinate granules (CBG) (markers for sludge and microlithiasis) in Type II and Type in SOD patients with the gallbladder (GB) in situ or removed. METHODS: During the past five years, 85 patients with unexplained pancreaticobiliary pain (66 F, 19 M; mean age, 38 yr) and no prior episodes of pancreatitis underwent sphincter of Oddi manometry (SOM) and bile crystal analysis. Eighty-one patients had a GB in situ and no evidence of stones or sludge on abdominal ultrasonography and/or CT scan. SOM was performed in the standard retrograde fashion using an aspirating catheter. SOD was diagnosed when the basal sphincter pressure was ≥ 40 mmHg. Bile was collected directly from the GB (n=23) after cystic duct cannulation with aid of a glidewire or from the common bile duct (n=62) following intravenous Kinevac (3 ug) infusion. Bile was evaluated by light and polarizing microscopy after centrifugation at 3000g for 10 minutes. All patients had a normal ERCP (except bile duct dilation in 14) and no evidence of GB filling defects. Patients were classified by their SOD type using a modified Hogan-Geenen system (Am J Gastoenterol 1991;86:586). RESULTS: This table shows the number of patients with CC or CBG of the total number of patients with a given SOD classification and GB status. SOD Normal SOM SOD Classification GB in GB out GB in GB out Total Type II 1/14* 0/2 0/18 0/0 1/34(2.9%) Type in 0/17 0/2 2/32* 0/0 2/51(3.9%) Total 1/31 0/4 2/50 0/0 3/85(3.5%) *Bile had cholesterol crystals SUMMARY: 1) One of the 35 Type II and Type III patients with manometrically documented sphincter of Oddi dysfunction had evidence of gallstone disease using CC and CBG as predictors. 2) Similarly, 2 of 50 Type II and Type m patients with normal manometry were found to have CC in bile. CONCLUSIONS: Microlithiasis appears to be extremely rare in Type II and Type III patients with either SOD or normal manometry. Evaluation of bile for crystals appears unproductive in this group of patients.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging