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Is hepatobiliary scintigraphy indeed insensitive for the diagnosis of sphincter of Oddi dysfunction?
  1. J Toouli
  1. Department of General and Digestive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia; jim.toouli{at}

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I was very pleased to read the letter by Dr Madacsy in response to our article “Scintigraphy versus manometry in patients with suspected sphincter of Oddi dysfunction” (


The major criticism of our study refers to the change from the original study of Sostre and colleagues1 that we made with regards to administration of cholecystokinin octapeptide (CCK-OP). I would like to refer the reader to our manuscript (

) for the explanation regarding this change, as detailed on 353, and discussed on 356. Previous studies have shown that a bolus injection of CCK-OP produces unpredictable results on the biliary tract. Furthermore, the half life of CCK-OP would eliminate its effect within three minutes of injection hence further complicate its reproducibility. The only means of overcoming these effects is via an infusion which has been shown to be the most reproducible means of CCK-OP administration. CCK-OP is given in this setting in order to relax the sphincter of Oddi. This is to eliminate transient spasm of the sphincter of Oddi as the cause of an abnormal scintigraphic score. To use an unpredictable means of achieving this end did not make sense to us, hence the adoption of an infusion.

Sphincter of Oddi manometry remains the only objective means of selecting patients with sphincter of Oddi dysfunction who may benefit from treatment. At present, we are developing a new catheter assembly system for manometric recording of the sphincter of Oddi, which we believe will eliminate the risk of pancreatitis. This catheter may replace triple lumen manometry and may become the new standard while we await the development of non-invasive reproducible diagnostic tests of sphincter of Oddi dysfunction.