Abstract
Sphincter of Oddi motility was measured in 55 gallstone patients either through the sinus tract of percutaneous transhepatic biliary drainage or through the T tube. The influence of cholecystectomy and gastrectomy on the sphincter of Oddi was analyzed by comparing responses in patients with or without surgery to the administration of cerulein and the ingestion of dry egg yolk. When comparing cholecystectomized patients to nonsurgical subjects, cholecystectomy revealed no influence on the response to cerulein and feeding. Both groups showed relaxation of contraction waves after provocations. On the other hand, two thirds of the postgastrectomy patients showed an acceleration in the contractions of the sphincter of Oddi after provocations (one third showed no change), while all of the nongastrectomy group saw the disappearance of the wave after cerulein administration and 83% revealed complete suppression of the wave after feeding. It is suspected that this paradoxical response to CCK on the sphincter of Oddi is a lithogenic factor after gastrectomy.
Similar content being viewed by others
References
Lorusso D, Misciagna G, Noviello MR, Tarantino S: Cholelithiasis after Billroth II gastric resection. Surgery 103:579–583, 1988
Hopman WPM, Jansen JBMJ, Lamers CBHW: Plasma cholecystokinin response to oral fat in patients with Billroth I and Billroth II gastrectomy. Ann Surg 199:276–280, 1984
Tompkins RK, Kraft AR, Zimmerman E, Lichtenstein JE, Zollinger RM: Clinical and biochemical evidence of increased gallstone formation after complete vagotomy. Surgery 71:196–200, 1972
Sapala MA, Sapala JA, Soto ADR, Bouwman DL: Cholelithiasis following subtotal gastric resection with truncal vagotomy. Surg Gynecol Obstet 148:36–38, 1979
Hauters P, Roden AN, Pourbaix A, Aupaix F, Coumans P, Therasse G: Cholelithiasis: A serious complication after total gastrectomy. Br J Surg 75:899–900, 1988
Gafa M, Sarli L, Miselli A, Pietra N, Carreras F, Peracchia A: Sludge and microlithiasis of the biliary tract after total gastrectomy and postoperative total parenteral nutrition. Surg Gynecol Obstet 165:413–418, 1987
Tinker J, Cox AG: Gallbladder function after vagotomy. Br J Surg 56:779–782, 1969
Malagelada JR, Go VLW, Summerskill WHJ: Altered pancreatic and biliary function after vagotomy and pyloroplasty. Gastroenterology 66:22–27, 1974
Isaza J, Jones DT, Dragstedt LR, Woodward ER: The effect of vagotomy on motor function of the gallbladder. Surgery 70:616–621, 1971
Inoue K, Fuchigami A, Hosotani R, Kogire M, Huang Y, Miyashita T, Suzuki T, Tsuda K, Seino Y, Rayford PL, Thompson JC, Tobe T: Release of cholecystokinin and gallbladder contraction before and after gastrectomy. Ann Surg 205:27–32, 1987
Johnson FE, Boyden EA: The effect of double vagotomy on the motor activity of the human gallbladder. Surgery 32:591–600, 1952
Allen B, Bernhoft R, Blanckaert N, Svanvik J, Filly R, Gooding G, Way L: Sludge is calcium bilirubinate associated with bile stasis. Am J Surg 141:51–56, 1981
Nebel OT: Manometric evaluation of the papilla of Vater Gastrointest Endosc 21:126–128, 1975
Tanaka M, Ikeda S, Nakayama F: Nonoperative measurement of pancreatic and common bile duct pressures with a microtransducer catheter and effects of duodenoscopic sphincterotomy. Dig Dis Sci 26:545–552, 1981
Bortolotti M, Caletti GC, Brocchi E, Bersani G, Guizzardi G, Labo G: Endoscopic electromyography and manometry of the human sphincter of Oddi. Hepato-Gastroenterol 32:250–252, 1985
Tanaka M, Ikeda S: Sphincter of Oddi manometry: Comparison of microtransducer and perfusion methods. Endoscopy 20:184–188, 1988
van Sonnenberg E, Ferrucci JT, Neff CC, Mueller PR, Simeone JF, Wittenberg J: Biliary pressure: Manometric and perfusion studies at percutaneous transhepatic cholangiography and percutaneous biliary drainage. Radiology 148:41–50, 1983
Steinberg WM: Sphincter of Oddi dysfunction: A clinical controversy. Gastroenterology 95:1409–1415, 1988
Nimura Y, Shionoya S, Hayakawa N, Kamiya J, Kondo S, Yasui A: Value of percutaneous transhepatic cholangioscopy (PTCS). Surg Endosc 2:213–219, 1988
Coelho JCU, Gouma DJ, Moody FG, Schlegel JF: Effect of feeding on myoelectric activity of the sphincter of Oddi and the gastrointestinal tract in the opossum. Dig Dis Sci 31:202–207, 1986
Shimayama T, Katsuki T, Kitamura N, Kondo K, Sakihama K: Etiological consideration of postgastrectomy cholelithiasis. Jpn J Gastroenterol Surg 17:1856–1860, 1984
Cowie AG, Clark CG: The lithogenic effect of vagotomy. Br J Surg 59:365–367, 1972
Strempel JM, Duane WC: Biliary lipids and bile acid pool size after vagotomy in man. Evidence against a predisposition to gallstones. Gastroenterology 75:608–611, 1978
Helm JF, Dodds WJ, Christensen J, Sarna SK: Control mechanism of spontaneous in vitro contractions of the opposum sphincter of Oddi. Am J Physiol 249:G572-G579, 1985
Toouli J, Hogan WJ, Geenen JE, Dodds WJ, Arndorfer RC: Action of cholecystokinin-octapeptide on sphincter of Oddi basal pressure and phasic wave activity in humans. Surgery 92:497–503, 1982
Behar J, Biancani P: Effect of cholecystokinin and the octapeptide cholecystokinin on the feline sphincter of Oddi and gallbladder. Mechanisms of action. J Clin Invest 66:1231–1239, 1980
LaMorte WW, Schoetz DJ, Gaca JM: Effect of cholecystokinin on the primary sphincter of Oddi. J Surg Res 32:44–50, 1982
Geenen JE, Hogan WI, Dodds WJ, Stewart ET, Arndorfer RC: Intraluminal pressure recording from the human sphincter of Oddi. Gastroenterology 78:317–323, 1980
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Odani, K., Nimura, Y., Yasui, A. et al. Paradoxical response to cerulein on sphincter of Oddi in the patient with gastrectomy. Digest Dis Sci 37, 904–911 (1992). https://doi.org/10.1007/BF01300389
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01300389