GALLBLADDER SLUDGE - SPONTANEOUS COURSE AND INCIDENCE OF COMPLICATIONS IN PATIENTS WITHOUT STONES

Although the ultrasonic detection of gallbladder sludge is relatively frequent, its clinical importance remains unclear, partly because of t he paucity of reliable investigations regarding its natural course in patients without stones. In a retrospective study we investigated the course and clinical significance of gallbladder sludge in patients wit hout stones or other identified gallbladder abnormalities. The diagnos is of gallbladder sludge was made by ultrasound scan in 286 (1.7%) of 17,021 patients. The mean follow-up period for these patients was 20.3 +/- 11.5 mo. Of this group 56 patients were without both stones and s ludge at the initial examination, and gallbladder sludge developed aft er a mean observation period of 11.2 +/- 10.6 mo. Within 2.0 +/- 3.5 m o after sludge detection, 40 (71.4%) patients were free of sludge and showed normal gallbladder findings. Gallbladder stones without sludge persistence developed in five patients (8.9%) within 2.5 +/- 0.6 mo af ter diagnosis of sludge, and gallstones with persistence of sludge dev eloped in two other patients (3.6%) after 6.1 and 30.7 mo, respectivel y. In no cases did the stones become clinically symptomatic in the cou rse of the follow-up period. Acute acalculous cholecystitis developed in four patients (7.1%) from 6.5 to 37.5 mo after the first examinatio n. In five patients, sludge persisted after a mean 22.3 +/- 13.5 mo of follow-up. Although our data show that gallbladder sludge disappeared spontaneously within a relatively short time in 71.4% of patients, ga llbladder sludge must be considered an important pathologic entity bec ause gallbladder stones or complications such as acute cholecystitis o ccurred in 19.6% of patients. It remains for prospective studies to in vestigate whether therapy of gallbladder sludge may reduce the inciden ce of complications, particularly the development of gallstones and ac ute cholecystitis. We were not able to observe acute pancreatitis at l east for the first year after sludge development.