INCREASED GALL-BLADDER VOLUME IN PRIMARY SCLEROSING CHOLANGITIS

Background-The diagnosis of primary sclerosing cholangitis (PSC) requi res invasive procedures such as liver biopsy and endoscopic retrograde cholangiography (ERC). Sonographic measurement of fasting gall bladde r volume, which has been reported to be enlarged in PSC, could serve a s a non-invasive screening test.Methods-Fasting gall bladder volume wa s studied in patients with PSC (n=24), primary biliary cirrhosis (PBC, n=13), liver cirrhosis due to other causes (n=18), ulcerative colitis (n=15), and healthy controls (n=23). Meal induced gall bladder emptyi ng was studied in patients with PSC, patients with PBC, and healthy co ntrols. Results-In patients with PSC gall bladder volume was greatly e nlarged (72.9 (SEM 3.7) ml) compared with healthy controls (25.4 (1.7) ml, and patients with PBC (30.9 (2.7) ml), liver cirrhosis (31.3 (4.0 ) ml) or ulcerative colitis (25.8 (2.0) ml) (p<0.0005 v all). In four patients with PSC the gap bladder wall was irregularly thickened (>4 m m) as previously described in PSC. Postprandial residual fractions (% of fasting volume) were comparable between patients with PSC (17.5 (3. 7)%) and those with PBC (23.6 (7.1%) and healthy controls (12.7 (2.3)% ) Although gall bladder emptying seems normal, increased biliary press ure in patients with PSC cannot be excluded. Conclusion-Apart from wal l thickening, patients with PSC often present with enlargement of the gall bladder. Sonographic determination of fasting gall bladder volume may be a useful, noninvasive, and easy to perform tool in the evaluat ion of patients suspected of having PSC.