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Use of 99mTc-DISIDA biliary scanning with morphine provocation for the detection of elevated sphincter of Oddi basal pressure


BACKGROUND Endoscopic biliary manometry is useful in the assessment of patients with types II and III sphincter of Oddi dysfunction, but it is time consuming and invasive.

AIM To investigate the role of 99mTc-DISIDA scanning, with and without morphine provocation, as a non-invasive investigation in these patients compared with endoscopic biliary manometry.

SUBJECTS AND METHODS A total of 34 patients with a clinical diagnosis of type II (n=21) or III (n=13) sphincter of Oddi dysfunction were studied. Biliary scintigraphy with 100 MBq of 99mTc-DISIDA was carried out with and without morphine provocation (0.04 mg/kg intravenously) and time/activity curves were compared with the results of subsequent endoscopic biliary manometry.

RESULTS Eighteen (nine type II, nine type III) of the 34 (53%) patients had sphincter of Oddi basal pressures above the upper limit of normal (40 mm Hg). In the standard DISIDA scan without morphine, no significant differences were observed in time to maximal activity (Tmax) or percentage excretion at 45 or 60 minutes between those with normal and those with abnormal biliary manometry. However, following morphine provocation, median percentage excretion at 60 minutes was 4.9% in those with abnormal manometry and 28.2% in the normal manometry group (p=0.002). Using a cut off value of 15% excretion at 60 minutes, the sensitivity for detecting elevated sphincter of Oddi basal pressure by the morphine augmented DISIDA scan was 83% and specificity was 81%. Also, 14 of the 18 patients with abnormal manometry complained of biliary-type pain after morphine infusion compared with only two of 16 patients in the normal manometry group (p=0.001).

CONCLUSIONS 99mTc-DISIDA with morphine provocation is a useful non-invasive investigation for types II and III sphincter of Oddi dysfunction to detect those with elevated sphincter basal pressures who may respond to endoscopic sphincterotomy.

  • sphincter of Oddi dysfunction
  • biliary manometry
  • 99mTc-DISIDA biliary scanning
  • radionuclide biliary imaging
  • biliary scintigraphy

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  • Abbreviations used in this paper:
    endoscopic biliary manometry
    endoscopic retrograde cholangiopancreatography
    General Electric
    per cent biliary emptying at 45/60 minutes
    sphincter of Oddi dysfunction
    sphincter of Oddi basal pressure
    time in minutes to maximal counts

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