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Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. May 14, 2006; 12(18): 2839-2845
Published online May 14, 2006. doi: 10.3748/wjg.v12.i18.2839
Evaluation of the biliary tract in patients with functional biliary symptoms
Peter Funch-Jensen, Asbjørn Mohr Drewes, László Madácsy
Peter Funch-Jensen, Surgical Gastroenterological Department L, Aarhus University Hospital, Aarhus, Denmark
Asbjørn Mohr Drewes, Center for Visceral Biomechanics and Pain, Department of Gastroenterology, Aalborg Sygehus and Center of Sensory Motor Interaction (SMI), University of Aalborg, Denmark
László Madácsy, First Department of Internal Medicine and OMCH Endoscopy Unit, Fejér Megyei Szent György Hospital, Székesfehérvár, Hungary
Correspondence to: Peter Funch-Jensen, MD, DMSc, Professor of Surgery, Surgical Gastroenterological Department L, Aarhus Sygehus, Aarhus University Hospital, DK-8000 Aarhus C, Denmark. funchjensen@gmail.com
Telephone: +45-86209065
Received: March 25, 2006
Revised: March 28, 2006
Accepted: April 10, 2006
Published online: May 14, 2006
Abstract

The aim of this paper was to describe functional biliary syndromes and methods for evaluation of the biliary tract in these patients. Functional biliary symptoms can be defined as biliary symptoms without demonstrable organic substrate. Two main syndromes exist: Gallbladder dysfunction and sphincter of Oddi dysfunction. The most important investigative tools are cholescintigraphy and endoscopic sphincter of Oddi manometry. In gallbladder dysfunction a scintigraphic gallbladder ejection fraction below 35% can select patients who will benefit from cholecystectomy. Endoscopic sphincter of Oddi manometry is considered the gold standard in sphincter of Oddi dysfunction but recent development in scintigraphic methods is about to change this. Thus, calculation of hilum-to-duodenum transit time and duodenal appearance time on cholescintigraphy have proven useful in these patients. In conclusion, ambient methods can diagnose functional biliary syndromes. However, there are still a number of issues where further knowledge is needed. Probably the next step forward will be in the area of sensory testing and impedance planimetric methods.

Keywords: Functional biliary pain; Scintigraphy; Manometry; Pain; Sphincter of Oddi; Gallbladder