Sonographic demonstration of duodenobiliary reflux with soda enhancement

Verification of Duodenobiliary Reflux With SPECT/CT Imaging

ABSTRACT

Duodenobiliary reflux is believed to be 1 of the causes of recurrent bacterial cholangitis. We reported a 65-year-old woman with intermittent epigastric pain for 20 years. She was diagnosed with cholelithiasis in the past, and she still had recurrent abdominal pain after the stone was removed. The patient was suspected of having duodenobiliary reflux and received duodenobiliary reflux imaging. After oral administration of 700 mL water containing 5 mCi 99mTc-DTPA, SPECT/CT images of the abdomen were acquired. Abnormal radioactivity was seen in the common bile duct, indicating the presence of duodenobiliary reflux.

Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination

BACKGROUND

Stone recurrence is a common late adverse event after ERCP in patients with common bile duct stones (CBDS). Duodenal-biliary reflux (DBR) is considered a major cause of CBDS recurrence. However, specific evidence is still lacking.

OBJECTIVE

To investigate the DBR rate in patients with recurrent CBDS after ERCP.

DESIGN

A prospective case-control study.

SETTING

A tertiary center.

PATIENTS

During follow-up, patients with a history of either recurrent CBDS (recurrence group) or nonrecurrent CBDS (control group) were invited to participate in the study. All patients had previously undergone successful CBDS removal by ERCP. Patients in the control group were matched with the recurrence group by age and gender in a 1:1 ratio. Patients with gallbladder stones, hepatolithiasis, remnant CBDS, CBD strictures, or stents were excluded.

INTERVENTIONS

Standard barium meal examination, MRCP, and enhanced abdominal CT.

MAIN OUTCOME MEASUREMENTS

DBR.

RESULTS

Thirty-two patients with a history of recurrent CBDS and 32 matched control subjects were enrolled. Baseline characteristics and parameters regarding the first ERCP were comparable between the 2 groups. The DBR rate was significantly higher in the recurrent than in the control group (68.8% vs 15.6%, P < .001). Multivariate analysis indicated that DBR (OR, 9.59; 95% CI, 2.65-34.76) and acute distal CBD angulation (OR, 5.48; 95% CI, 1.52-19.78) were independent factors associated with CBDS recurrence. DBR rates in patients with no, single, or multiple recurrences were 15.6%, 60.9%, and 88.9%, respectively (P < .001). Intrahepatic bile duct reflux was more common in patients with multiple recurrences.

LIMITATIONS

Small sample size.

CONCLUSIONS

DBR is correlated with CBDS recurrence in patients who had previously undergone ERCP. DBR and acute distal CBD angulation are 2 independent risk factors related to stone recurrence. (

CLINICAL TRIAL REGISTRATION NUMBER

NCT02329977.)

Imaging diagnosis--duodenobiliary reflux of barium sulfate during esophagogastrography in a dog

A 4-year-old Australian cattle dog presented for regurgitation, 2 months after duodenal resection and anastomosis for a perforated duodenal ulcer. Duodenobiliary reflux of barium sulfate suspension was detected during fluoroscopic esophagogastrography. Follow-up radiography 2 hours later demonstrated persistence of the barium in the gallbladder and biliary tree. Ultrasonography showed an open sphincter of Oddi but no other morphological abnormalities with the gallbladder or biliary system. No side effects or bloodwork abnormalities were noted. This is the first case report of duodenobiliary reflux of barium in a dog. The pathophysiology of this phenomenon and its incidence and significance in human medicine are discussed.

Sphincter of Oddi manometry by choledochoscope in patients with duodenobiliary reflux

BACKGROUND AND AIM

  Previous research has confirmed that duodenobiliary reflux exists in patients with choledocholithiasis. The objective of this study was to investigate whether the motor activity of the sphincter of Oddi (SO) has an effect on duodenobiliary reflux.

METHODS

  A total of 51 patients orally ingested 1mL water containing technetium-99m diethylenetriaminepentaacetatic acid, and a 2-h bile collection was obtained from the T tube. Technetium counts in the collected bile were performed using an RM905 radioactivity meter. The patients were divided into two groups: reflux group (duodenobiliary reflux positive) and control group (duodenobiliary reflux negative). Next, 33 cases were randomly selected and double blinded to receive SO manometry by choledochoscope.

RESULTS

  Of the 51 total cases, 16 bile samples exhibited radioactivity. The average SO basal pressure and contraction pressure values were 7.2±3.9mmHg and 53.5±24.5mmHg, respectively, in the reflux group, and 14.7±11.0mmHg and 117.2±65.6mmHg, respectively, in the control group. The choledochus pressure values were 5.1±1.6mmHg and 11.5±7.4mmHg in the reflux group and the control group, respectively. The differences between the groups were statistically significant; however, the SO contraction frequency, SO contraction duration, and duodenum pressure values were not significantly different between the groups.

CONCLUSION

  The decreases in the SO basal pressure and SO contraction pressure, and the decrease in choledochus pressure, might play a role in duodenobiliary reflux.

Relationship between duodenobiliary reflux and pressure of Oddi sphincter

AIM: To observe the relationship between duodenobiliary reflux in patients who underwent choledocholithotomy plus T-tube drainage and pressure of Oddi sphincter.

METHODS: A total of 51 patients who underwent choledocholithotomy plus T-tube drainage were studied. After duodenobiliary reflux due to oral 185 MBq (5 mCi) of technetium-99m diethylenetriaminepentaacetatic acid (^99mTc-DTPA) was observed, the patients were divided into reflux group positive for duodenobiliary reflux and control group negative for duodenobiliary reflux. Thirty-three of them were selected randomly and the pressure of Oddi sphincter was assessed by choledochoscope manometry to find if there is a certain relationship between them.

RESULTS: Duodenobiliary reflux was detected in 31% (16/51) of the patients who underwent choledocholithotomy plus T-tube drainage and in 10 of the 33 randomly selected patients, while no duodenobiliary reflux was detected in the remaining 23 patients of the control group. The basal pressure and contraction amplitude of Oddi sphincter and the pressure of common bile duct were significantly lower in the reflux group than in the control group (7.2 ± 3.9 mmHg vs 14.7 ± 11.0 mmHg, 53.5 ± 24.5 mmHg vs 117.2 ± 65.6 mmHg, 5.1 ± 1.6 mmHg vs 11.5 ± 7.4 mmHg, P < 0.05). No significant difference was found in the frequency of contractions, duration of contractions or pressure of common bile duct between the two groups.

CONCLUSION: The occurrence of duodenobiliary reflux is related with the contraction amplitude and basal pressure of Oddi sphincter and the common bile duct pressure, but not with the contraction frequency and duration of Oddi sphincter and the pressure of common bile duct. Duodenobiliary reflux may play a role in the pathogenesis of choledocholithiasis.

Establishing a methodology for detection and confirmation of duodenal-biliary reflux

AIM: To determine methods for detection and confirmation of duodenal-biliary reflux.

METHODS: One hundred and twenty-three patients with a T tube after cholecystectomy and choledochotomy were randomly divided into reflux and non-reflux groups by measuring the amount of radioactivity of ^99mTc-DTPA, ICG, amylase, lipidase and pepsinogen II in the bile. The incidence rate for barium in the biliary tract after barium meal examination was recorded to confirm the existence of duodenal-biliary reflux.

RESULTS: The amount of radioactivity of ^99mTc-DTPA, ICG, amylase and lipidase in the bile of patients with a T tube after cholecystectomy and choledochotomy was detected to a varying extent. Radioactivity of ^99mTc-DTPA provided the most sensitive measure.

CONCLUSION: Establishing a methodology for detection and confirmation of duodenal-biliary reflux has an important role in research into estimating the structure and function of the Oddi sphincter and formation of bile duct pigment stones.