„Stone splinter“ like phasic contraction abnormality of the human sphincter of ODDI (SO) – a preliminary report of two cases documented by endoscopic so manometry

Introduction: Currently elevated SO basal pressure is the only accepted manometric abnormality in patients with postcholecystectomy pain and SO dysfunction (SOD) that necessitates therapeutic measures such as endoscopic sphincterotomy (EST). Although normal ranges of SO phasic contractions (PCs) are well described in healthy volunteers, no specific PC abnormalities were characterized in SOD patients.

Patients and methods: We retrospectively analyzed our endoscopic SO manometric (ESOM) database of 57 separate manometric recordings of 52 patients. PC activity of the SO could be sufficiently analyzed on 41 ESOM recordings. The average amplitude, duration and frequency of SO and also the duodenal activity were calculated. The measurement of ESOM was performed with a Synectic perfusion manometric system with our standard station-pull-through technique.

Results: In 39 patients with normal appearance of the PC of the SO, the average PC amplitude, duration and frequency were 153.8+68.7mmHg, 7.6+1.0s, and 1.1+0.3/min respectively. The amplitude, duration and frequency of the duodenal contractions on ESOM were 71.8+16.7mmHg, 2.8+0.4s. and 3.5+2.4/min respectively. In two patients with functional biliary pain we detected SO PCs with significantly higher amplitude and longer duration but similar frequency: 429.1+130.6mmHg, 11.7+2.1s. and 1.1+0.2/min respectively. Most of these PCs had simultaneous propagation tendency. Both patients improved symptomatically after EST.

Conclusion: Similarly to the motility pattern of nutcracker esophagus, in a small percentage of patients with SOD extremely high amplitude and longer duration SO PCs were detected. So called „stone splinter“ PCs might be a unique abnormality that are responsible for biliary symptoms.