Endoscopic Manometry of the Sphincter of Oddi in Patients with and without Juxtapapillary Duodenal Diverticula

Abstract

The motor activity of the sphincter of Oddi (SO) has been evaluated, by endoscopic manometry, in 48 subjects. 8 with and 40 without duodenal juxtapapillary diverticula. All values were expressed in mm Hg, taking duodenal pressure as zero reference. In subjects with diverticula the SO basal pressure was 14.1 ± 4.3 mm Hg, peak pressure was 52.3 ± 17.2 mm Hg, and wave height was 39.75 ± 14.19 mm Hg; in subjects without diverticula these values were 31.2 ± 8.9 mm Hg. 93.2 ± 21.3 mm Hg, and 68.17 ± 25.86. respectively. The difference was statistically significant (P < 0.001 for basal and peak pressure; P < 0.002 for wave height). Wave frequency was not significantly different in controls (4.99 ± 1.17/min) and in subjects with diverticula (4.98 ± 1.13/min). These findings seem to indicate that in patients with diverticula the SO is insufficient or dysfunctioning. The insufficiency of the SO and a reflux of bacteria from the duodenum into the bile duct could play a major role in the formation of stones in patients with diverticula. The same mechanism could be responsible for duodenopancreatic reflux and possible pancreatic lesion.

Key words:

• Diverticula
• duodenum
• endoscopy
• manometry
• Oddi sphincter
• Vater's papilla