Diagnosis of sphincter of Oddi dysfunction in patients with postcholecystectomy syndrome from hepatobiliary scintigraphic findings
Objective: to diagnose and estimate the clinical value of post­cholecystectomy sphincter of Oddi dysfunction in patients. Material and methods. Examinations were made in 100 postc­holecystectomy patients without signs of cholestasis; of them 14 postpapillotomy patients formed a comparison group. Hepato­biliary scintigraphy using the radiotracer 99mTC-bromeside was performed for 90 minutes with cholagogue breakfast at 45 min­utes. Common bile duct and duodenal functions and duodenogas-tric reflux (DGR) were evaluated comparing them with clinical, laboratory, and instrumental findings. Results. Two patient groups were identified according to bile outflow changes. In Group 1 consisting of 20 (23.2%) patients, the time of maximum accumulation (T max) of the radiopharma-ceutical in the projection of the choledochus coincided with that in the cholagogue test (46.0±1.8 min) and in Group 2 including 66 (76.8%) patients that was shorter than in the cholagogue test (32.9±6.8 min) (p max was similar to that in the comparison group (30.9±7.5 min; р >0.05) and there was no significant difference in intestinal imaging time (18.6±6.0 min versus 17.6±0.8) either, which could be indicative of sphincter of Oddi dysfunction. Diarrhea was observed in 73% of the patients with sphincter of Oddi dysfunction and in 86% of the patients in the comparison group versus 10% of the patients with normal bile passage (p <0.01). Statistical data processing showed a correlation of the indicators of sphincter of Oddi dysfunction with those of duodenal evacuator function (r =0.57; p <0.0005) and DGR (r = 0.74; p <0.009). Conclusion. Postcho- lecystectomy sphincter of Oddi dysfunction assumes the greatest clinical value in patients with duodenal motor-evacuator dysfun­ction, which should be kept in mind when choos­ ing a treatment policy.