Abstracts
1998 Digestive Disease Week

#1048

INTRA-OPERATIVE BILIARY MANOMETRY IN THE EVALUATION OF CHRONIC ACALCULOUS CHOLECYSTITIS. Scott W. Lucas and Maurice E. Arregui, St. Vincent Hospital and Health Center. Indianapolis, IN.

We performed trans-cystic biliary manometry in patients undergoing laparoscopic cholecystectomy (LC) for chronic acalculous cholecystitis (CAC) to assess the role of sphincter of Oddi dysfunction (SOD) in this disease. Sixty patients diagnosed with CAC agreed to trans-cystic biliary manometry at the time of LC. A perfused triple-lumen catheter was used with a pull-through technique. Abnormal manometry was defined as sustained pressure greater than 40 mm Hg, >8 contractions per minute, high amplitude peak pressures, or >50% retrograde contractions. Operative and pathologic findings were noted, and follow-up was through office visits and telephone contacts. Manometry was successfully completed in 44 of 60 patients. Fifty-two percent of patients had abnormal studies, and 48% were normal. Manometry was unsuccessful in 36% due to technical problems. At an average of 13.2 months follow-up (range 1-38), 50% were asymptomatic and 42% had improvement, while 8% had no improvement. Of those with abnormal manometry, 27% were asymptomatic and 59% improved, and 4% had no change. In the group with normal studies 71% were asymptomatic, 19% improved, and 10% had no improvement. The difference in outcome between these groups was significantly different (p<0.005). In patients in whom manometry was not completed, 50% were asymptomatic, 38% improved, and 13% were unchanged. Biliary manometry is abnormal in a high percentage of patients with CAC, implicating SOD as a frequent etiologic factor. Patients with normal SO manometry are more likely to have complete resolution of symptoms than those with abnormal studies.

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