BILIARY MOTILITY

The control and operation of the gallbladder and sphincter of Oddi in modulating biliary pressure and bile flow continues to be elucidated and adapted to clinical situations. Prokinetic drugs may be useful in preventing stone formation in high-risk patients by promoting gallbladder emptying. Cholescintigraphy has been considered the most accurate test in evaluating acute cholecystitis. Now, cholecystokinin-assisted cholescintigraphy scans assess the gallbladder ejection fraction and detect chronic noncalculous gallbladder disease in the majority of these patients. Sphincter of Oddi manometric studies have helped in detecting sphincter of Oddi dysfunction and now better define patient groups and their outcomes to.therapy. Finally, direct neural pathways have been demonstrated to connect the duodenum with the gallbladder and sphincter of Oddi, and the sphincter of Oddi with the gallbladder, confirming the existence of a highly integrated network that modulates biliary dynamics.