Some of what glitters may be gold

U. S. Karnam, J. B. Raskin, A. I. Rogers

Research output: Contribution to journalReview article

Abstract

This prospective study evaluated the role of 99mTc-DISIDA scanning, with and without morphine provocation, as a better noninvasive investigation of patients with types II and III sphincter of Oddi dysfunction (SOD) than the gold standard - endoscopic biliary manometry. Thirty-four patients with clinical diagnosis of types II (n = 21) or III (n = 13) SOD were investigated with and without morphine augmented 99mTc-DISIDA biliary scanning. Eighteen of the 34 patients (53%) had sphincter of Oddi basal pressures above 40 mm Hg. In the standard DISIDA scan (controls), no significant differences in isotope excretion were observed between those with normal and abnormal biliary manometry (>40 mm Hg basal sphincter pressure). Following morphine provocation (0.04 mg/kg in 10 ml of normal saline administered intravenously over 5 min), median percentage excretion at 60 min was 4.9% in those with abnormal manometry and 28.2% in the normal manometry group (p = 0.002). The sensitivity of the morphine augmented DISIDA scan was 83%, and specificity was 81% when 15% excretion at 60 min was used as the cut-off value. Seventy-seven percent of the patients with raised basal sphincter of Oddi pressures complained of biliary-type pain after morphine infusion compared with only 12.5% of patients in the normal manometry group (p = 0.001). The authors concluded that 99mTc-DISIDA with morphine provocation is a useful, noninvasive test for those patients presenting syndromes consistent with types II and III SOD. In these subsets, this test appears to detect those patients with elevated basal sphincter pressures who may respond to therapies directed at reducing or interrupting sphincter of Oddi tone.

Original languageEnglish (US)
Pages (from-to)247-248
Number of pages2
JournalAmerican Journal of Gastroenterology
Volume96
Issue number1
StatePublished - Feb 8 2001

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Karnam, U. S., Raskin, J. B., & Rogers, A. I. (2001). Some of what glitters may be gold. American Journal of Gastroenterology, 96(1), 247-248.