Evaluation of Sphincter of Oddi Function

Disorders of sphincter of oddi motility are being recognized as a cause for post‐cholecystectomy pain. Objective diagnosis of sphincter of oddi dysfunction is difficult because of the relative inaccessibility of the sphincter. In recent years, a number of investigations have been used in order to diagnose motility disorders of the sph meter of oddi. The most useful of these investigations is endoscopic manometry. However, in addition, the morphine neostigmine provocation test, radioscintigraphy to assess bile flow, and assessment of pancreatic duct diameter following secretin infusion have been used. Specificity and sensitivity for all of these investigations of sphincter of oddi function have been difficult to obtain due to the small number of patients and the heterogeneity of sphincter of oddi abnormalities. Based on the manometry measurements, two major subgroups of sphincter of oddi dysfunction have been defined. One group of patients exhibits a high basal pressure consistent with stenosis and the second demonstrates a number of dyskinetic patterns. Prospective studies currently underway will best define the most appropriate therapy for these disorders.