Normal pyloric sphincter competence evaluation as based on 148 T tube cholangiograms

T tube examinations were studied in 116 patients who had a combined total of 148 postoperative cholangiograms. Of the 148, only 2 showed retrograde fill of the stomach. Because some 43 operative cholangiograms were miscoded as postoperative studies, it was decided to evaluate these separately, even though these were not a complete survey of surgical examinations and not considered eligible for inclusion. In this group, even with anesthetic alteration of sphincter tone, only 4 of the 43 showed gastric reflux. The purposeful avoidance, if possible, of ampullary sphincter spasm with a limited volume of contrast is possibly the most striking difference in the planned compared with this retrospective study. The authors try to avoid ampullary spasm and pain, which may initiate reversed peristalsis and increased intraduodenal pressure thereby producing reflux and/or vomiting. Thus, it is the authors' impression that the statement that gastric reflux of duodenal content is a physiologic variant is not the case. Instead, as based on 148 separate postoperative studies in 116 patients, reflux into the stomach occurred only twice suggesting the validity of the accepted concept that pyloric reflux is abnormal.