Biliary scintigraphy versus sphincter of Oddi manometry in patients with post-cholecystectomy pain: is it time to disregard the scan?

Sphincter of Oddi (SO) dysfunction is diagnosed using manometry, and patients with an abnormal SO basal pressure respond well to division of the SO. However, manometry is invasive and is associated with a low, yet significant, incidence of complications. Scintigraphy techniques have been developed with the aim of providing a noninvasive means of assessing SO motility. However, when compared with SO manometry these techniques fall short in sensitivity and specificity for diagnosing SO dysfunction. Furthermore, they do not select patients who will respond to treatment. Consequently, the quest for development of a noninvasive investigation for diagnosis of SO dysfunction continues. In the mean time, improved manometric techniques that enhance reproducibility and reduce complications have been developed.