Variable loading cholangiomanometry and clinical applications.

We have designed a variable loading cholangiomanometric method, which permits a precise and objective evaluation of distal bile duct function. Normal resistance (R) values (1-7 units) and residual pressure (P) values (50-150 mm H2O) have been defined by this method. We have performed this procedure on 138 patients with cholelithiasis, and have found that 13 patients with cholecystolithiasis and 14 patients with choledocholithiasis have elevated R and P values in the distal bile duct. These patients also had morphological abnormalities in the distal bile duct. There was a high percentage of patients with abnormal pressure/flow curves at high flow rates among patients with morphologically dilated bile ducts. Division of pressure/flow curve patterns at low flow rates into three types made it possible to differentiate between functional and structural abnormalities. Patients in whom the residual P values were high and morphological defects of the distal bile duct. The possible application of these measurements in determining the need for additional surgery on the inferior bile duct, particularly papilloplasty, is discussed.