Perfusion cholangiomanometry by papillary stimulation with hydrochloric acid A new classification and its clinical significance

• Published in: Tando Vol. 2; no. 4; pp. 451 - 458
• Main Authors: MATSUSHIROK, Takashi, YAMAMOTO, Kyoji, YAMAGUCHI, Hisashi, IMAOKA, Youichi, HARIU, Tsuneo, NAGASHIMA, Hideyuki
• Format: Journal Article
• Language: Japanese
• Published: Japan Biliary Association 25.10.1988
• ISSN: 0914-0077; 1883-6879
• DOI: 10.11210/tando1987.2.4_451

Perfusion cholangiomanometry by dilute hydrochloric acid stimulation was carried out on 212 patients having benign biliary tract diseases, and the data were analyzed relative to their clinical findings, surgical findings, and distant prognostic results. The manometric curve patterns appeared to permit proposal of a new classification, offering better clinical usefulness. Type I (normoreacting type) A flat perfusion pressure pattern with high amplitude spikes; Type II (hypertonic type): The perfusion pressure rises steeply; Type 111(hypotonic type): The flat and low perfusion pressure pattern. Additional subclassification was made into II a, II b, JJaf and 11b1 according to the responsiveness to stimulation with dilute hydrochloric acid.11 a seemed to reflect papillary stenosis. Its histopathological findings were those of acute inflammation, and were reversible papillitis. Some 85% of II b were cases of gallstone incarceration in the lower part of choledochus. The histopathological pictures of type, especially E b were characterized by connective tissue proliferation in the papilla. Most of IIIb cases appeared irreversible papillitis. For the purpose of differentiati o n of their reversibility, observation of the reaction to an i. v. dose of pentazocine seemed appropriate enough. Duodenal papillitis was concluded to proceed from II a through a to III b.