DUODENAL BILE EXAMINATION IN IDENTIFYING POTENTIAL NONRESPONDERS TO BILE-SALT TREATMENT AND ITS COMPARISON WITH GALL-BLADDER BILE EXAMINATION

The results of bile salt treatment in patients with radiolucent stones and a functioning gall bladder have been poor, In 42 of these patient s awaiting cholecystectomy we determined the value of duodenal bile ex amination in predicting gall stone composition, and thus identifying t hose less likely to respond to bile salt therapy. Based on chemical an alysis and scanning electron microscopy, 28 of 42 (67%) gall stones re trieved at surgery were potentially insoluble. Microscopic examination of duodenal bile correctly identified 21 (75%) of them: it predicted all four (100%) pigment stones, three of six (50%) calcium carbonate c ontaining cholesterol stones, and 14 of 18 (78%) cholesterol stones wi th pigment shells. It was nearly as reliable as microscopic examinatio n of bile aspirated directly from the gall bladder during surgery (21 (75%) v 23 (82%); p=NS). Furthermore, the presence of cholesterol crys tals in duodenal bile was a more sensitive indicator than chemical det ection of supersaturation (34 of 38 (89%) v 25 of 35 (71%); p<0.05) fo r prediction of cholesterol gall stones. Microscopic examination of du odenal bile, if used as a screening test, could help to exclude potent ial non-responders and thereby improve considerably the results of ora l bile salt treatment for gall stone dissolution.