POSTPRANDIAL GALLBLADDER MOTOR FUNCTION - REFILLING AND TURNOVER OF BILE IN HEALTH AND IN CHOLELITHIASIS

Background and Aims: Impaired gallbladder emptying is implicated in ga llstone disease. Ultrasonography and scintigraphy have shown conflicti ng results because the former is influenced by postprandial refilling, whereas the latter is not influenced by refilling. The aim of this st udy was to measure postprandial refilling and turnover of bile by comb ining the two techniques. Methods: Simultaneous scintigraphy and ultra sonography were used in 14 patients with gallstones and 11 healthy con trols. Measurements were performed while the patients were fasting and at 10-minute intervals after a standard meal for 90 minutes, and the measurements were used to calculate postprandial refilling, turnover o f bile (in milliliters), and turnover index. Results: Ultrasonography and scintigraphy provided different gallbladder emptying patterns. Com pared with controls, patients with gallstones had impaired emptying by both scintigraphy (P < 0.0001) and ultrasonography (P < 0.01). Postpr andial refilling and turnover were both reduced between 60 and 90 minu tes (P < 0.05), and the turnover index was markedly reduced (1.8 vs. 3 .5; P < 0.001). Conclusions: Simultaneous scintigraphy and ultrasonogr aphy provide a new model of gallbladder motor function showing that re filling begins immediately postprandially. In healthy controls, the ga llbladder postprandially handles up to six times its basal volume with in a period of 90 minutes, but this turnover of bile is markedly reduc ed in cholelithiasis causing a reduced washout effect of the gallbladd er contents, including cholesterol crystals.