Pressure measurements in the biliary and pancreatic duct systems in controls and in patients with gallstones, previous cholecystectomy, or common bile duct stones

Abstract Resting common bile duct, main pancreatic duct, and resting Oddi sphincter pressures were measured in controls and in patients with gallstones, previous cholecystectomy, common bile duct stones, hepatic duct cancer, and chronic pancreatitis. No significant differences in resting common bile duct pressures were observed in controls compared with the other groups. No significant differences in resting intrapancreatic duct pressure were observed in controls compared with patients with various biliary diseases. Resting intrapancreatic duct pressure was two to three times greater than the common bile duct pressure in all patients. No motor activity was found in either of the ducts. Only passive transmission of changes in intraabdominal pressures was demonstrated. No correlation between diameter of the ducts and intraluminal pressure was observed. The injection of a known volume of normal saline or contrast medium was associated with abrupt increase in intraluminal pressure, and in some patients typically biliary cholics were produced. Oddi sphincter pressure caused a phasic activity composed of contractions and relaxations in all patients. Peak Oddi sphincter pressure was approximately 100 mm Hg above the duodenal pressure, and no significant differences were seen in controls compared with any other group (P > 0.4). The results of this study show that a unique high pressure zone with sphincter characteristics exists at the level of the choledochoduodenal and pancreaticoduodenal junction, and that it is independent of duodenal dynamics. This sphincter creates a gradient between the bile or pancreatic ducts and the duodenum, and probably prevents reflux of duodenal content into these ducts.