Investigation of Oddi sphincter structure by optical coherence tomography in patients with biliary-type 1 dysfunction

A pilot in vivo study

P. A. Testoni, B. Mangiavillano, A. Mariani, S. Carrara, C. Notaristefano, P. G. Arcidiacono

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Type 1 sphincter of Oddi dysfunction is a clinical entity characterised by biliary-type pain, elevated liver biochemical tests, and common bile duct dilation. Sphincter fibrosis is a common finding in this type of dysfunction and may require in some cases a differential diagnosis with a malignant intra-papillary disease. Optical coherence tomography permits high-resolution, real-time imaging of the sphincter of Oddi microstructure by a probe inserted into the common bile duct through an ERCP catheter. No data exist on the evaluation of sphincter of Oddi fibrosis by optical coherence tomography during ERCP in vivo. Objective: To assess the feasibility of optical coherence tomography investigation of the sphincter of Oddi structure and assess its potential for diagnosing type 1 sphincter of Oddi dysfunction. Patients: Ten consecutive patients, five with biliary-type 1 sphincter of Oddi dysfunction and five with pancreatic head/mid-body adenocarcinoma not involving the papillary region, who underwent both endoscopic ultrasound and therapeutic ERCP, were investigated by optical coherence tomography immediately before biliary sphincterotomy or stenting. Results: In all sphincter of Oddi dysfunction patients optical coherence tomography recognised a hyper-reflective intermediate, fibro-muscular layer, significantly thicker than in patients with non-pathological sphincter of Oddi (p <0.0001). Conclusions: Optical coherence tomography imaging recognised an increased thickness and reflectance of the fibro-muscular layer of the sphincter of Oddi, very likely determined by fibrosis, and was not time-consuming; it can be safely used during ERCP to confirm the diagnosis in difficult cases. Its use in clinical practice has one important limitation since it requires magnification in the post-procedure computer analysis to obtain images useful for diagnosis.

Original languageEnglish
Pages (from-to)907-912
Number of pages6
JournalDigestive and Liver Disease
Volume41
Issue number12
DOIs
Publication statusPublished - Dec 2009

Fingerprint

Sphincter of Oddi
Optical Coherence Tomography
Sphincter of Oddi Dysfunction
Endoscopic Retrograde Cholangiopancreatography
Fibrosis
Common Bile Duct
Dilatation
Adenocarcinoma
Differential Diagnosis
Catheters
Pain
Liver

Keywords

  • ERCP Endoscopic Retrograde Cholangio-Pancreatography
  • OCT
  • Sphincter of Oddi dysfunction

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Investigation of Oddi sphincter structure by optical coherence tomography in patients with biliary-type 1 dysfunction : A pilot in vivo study. / Testoni, P. A.; Mangiavillano, B.; Mariani, A.; Carrara, S.; Notaristefano, C.; Arcidiacono, P. G.

In: Digestive and Liver Disease, Vol. 41, No. 12, 12.2009, p. 907-912.

Research output: Contribution to journalArticle

@article{2cb21d69c8c04d0a9ed97303d4600ec9,
title = "Investigation of Oddi sphincter structure by optical coherence tomography in patients with biliary-type 1 dysfunction: A pilot in vivo study",
abstract = "Background: Type 1 sphincter of Oddi dysfunction is a clinical entity characterised by biliary-type pain, elevated liver biochemical tests, and common bile duct dilation. Sphincter fibrosis is a common finding in this type of dysfunction and may require in some cases a differential diagnosis with a malignant intra-papillary disease. Optical coherence tomography permits high-resolution, real-time imaging of the sphincter of Oddi microstructure by a probe inserted into the common bile duct through an ERCP catheter. No data exist on the evaluation of sphincter of Oddi fibrosis by optical coherence tomography during ERCP in vivo. Objective: To assess the feasibility of optical coherence tomography investigation of the sphincter of Oddi structure and assess its potential for diagnosing type 1 sphincter of Oddi dysfunction. Patients: Ten consecutive patients, five with biliary-type 1 sphincter of Oddi dysfunction and five with pancreatic head/mid-body adenocarcinoma not involving the papillary region, who underwent both endoscopic ultrasound and therapeutic ERCP, were investigated by optical coherence tomography immediately before biliary sphincterotomy or stenting. Results: In all sphincter of Oddi dysfunction patients optical coherence tomography recognised a hyper-reflective intermediate, fibro-muscular layer, significantly thicker than in patients with non-pathological sphincter of Oddi (p <0.0001). Conclusions: Optical coherence tomography imaging recognised an increased thickness and reflectance of the fibro-muscular layer of the sphincter of Oddi, very likely determined by fibrosis, and was not time-consuming; it can be safely used during ERCP to confirm the diagnosis in difficult cases. Its use in clinical practice has one important limitation since it requires magnification in the post-procedure computer analysis to obtain images useful for diagnosis.",
keywords = "ERCP Endoscopic Retrograde Cholangio-Pancreatography, OCT, Sphincter of Oddi dysfunction",
author = "Testoni, {P. A.} and B. Mangiavillano and A. Mariani and S. Carrara and C. Notaristefano and Arcidiacono, {P. G.}",
year = "2009",
month = "12",
doi = "10.1016/j.dld.2009.03.015",
language = "English",
volume = "41",
pages = "907--912",
journal = "Digestive and Liver Disease",
issn = "1590-8658",
publisher = "Elsevier B.V.",
number = "12",

}

TY - JOUR

T1 - Investigation of Oddi sphincter structure by optical coherence tomography in patients with biliary-type 1 dysfunction

T2 - A pilot in vivo study

AU - Testoni, P. A.

AU - Mangiavillano, B.

AU - Mariani, A.

AU - Carrara, S.

AU - Notaristefano, C.

AU - Arcidiacono, P. G.

PY - 2009/12

Y1 - 2009/12

N2 - Background: Type 1 sphincter of Oddi dysfunction is a clinical entity characterised by biliary-type pain, elevated liver biochemical tests, and common bile duct dilation. Sphincter fibrosis is a common finding in this type of dysfunction and may require in some cases a differential diagnosis with a malignant intra-papillary disease. Optical coherence tomography permits high-resolution, real-time imaging of the sphincter of Oddi microstructure by a probe inserted into the common bile duct through an ERCP catheter. No data exist on the evaluation of sphincter of Oddi fibrosis by optical coherence tomography during ERCP in vivo. Objective: To assess the feasibility of optical coherence tomography investigation of the sphincter of Oddi structure and assess its potential for diagnosing type 1 sphincter of Oddi dysfunction. Patients: Ten consecutive patients, five with biliary-type 1 sphincter of Oddi dysfunction and five with pancreatic head/mid-body adenocarcinoma not involving the papillary region, who underwent both endoscopic ultrasound and therapeutic ERCP, were investigated by optical coherence tomography immediately before biliary sphincterotomy or stenting. Results: In all sphincter of Oddi dysfunction patients optical coherence tomography recognised a hyper-reflective intermediate, fibro-muscular layer, significantly thicker than in patients with non-pathological sphincter of Oddi (p <0.0001). Conclusions: Optical coherence tomography imaging recognised an increased thickness and reflectance of the fibro-muscular layer of the sphincter of Oddi, very likely determined by fibrosis, and was not time-consuming; it can be safely used during ERCP to confirm the diagnosis in difficult cases. Its use in clinical practice has one important limitation since it requires magnification in the post-procedure computer analysis to obtain images useful for diagnosis.

AB - Background: Type 1 sphincter of Oddi dysfunction is a clinical entity characterised by biliary-type pain, elevated liver biochemical tests, and common bile duct dilation. Sphincter fibrosis is a common finding in this type of dysfunction and may require in some cases a differential diagnosis with a malignant intra-papillary disease. Optical coherence tomography permits high-resolution, real-time imaging of the sphincter of Oddi microstructure by a probe inserted into the common bile duct through an ERCP catheter. No data exist on the evaluation of sphincter of Oddi fibrosis by optical coherence tomography during ERCP in vivo. Objective: To assess the feasibility of optical coherence tomography investigation of the sphincter of Oddi structure and assess its potential for diagnosing type 1 sphincter of Oddi dysfunction. Patients: Ten consecutive patients, five with biliary-type 1 sphincter of Oddi dysfunction and five with pancreatic head/mid-body adenocarcinoma not involving the papillary region, who underwent both endoscopic ultrasound and therapeutic ERCP, were investigated by optical coherence tomography immediately before biliary sphincterotomy or stenting. Results: In all sphincter of Oddi dysfunction patients optical coherence tomography recognised a hyper-reflective intermediate, fibro-muscular layer, significantly thicker than in patients with non-pathological sphincter of Oddi (p <0.0001). Conclusions: Optical coherence tomography imaging recognised an increased thickness and reflectance of the fibro-muscular layer of the sphincter of Oddi, very likely determined by fibrosis, and was not time-consuming; it can be safely used during ERCP to confirm the diagnosis in difficult cases. Its use in clinical practice has one important limitation since it requires magnification in the post-procedure computer analysis to obtain images useful for diagnosis.

KW - ERCP Endoscopic Retrograde Cholangio-Pancreatography

KW - OCT

KW - Sphincter of Oddi dysfunction

UR - http://www.scopus.com/inward/record.url?scp=70350572270&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70350572270&partnerID=8YFLogxK

U2 - 10.1016/j.dld.2009.03.015

DO - 10.1016/j.dld.2009.03.015

M3 - Article

VL - 41

SP - 907

EP - 912

JO - Digestive and Liver Disease

JF - Digestive and Liver Disease

SN - 1590-8658

IS - 12

ER -