THE RELATION BETWEEN BILIARY LIPIDS, NUCLEATION TIME, AND NUMBER OF GALLBLADDER STONES AFTER PERCUTANEOUS GALLBLADDER PUNCTURE

Background: Biliary lipids and nucleation time are increasingly of imp ortance in the understanding of the cholesterol nucleation process in gallstone patients. Methods: Biliary lipids, total lipid concentration (TLC), cholesterol saturation index (CSI) and nucleation time (NT) we re studied in 221 bile samples from patients with solitary (n = 120) a nd multiple (n = 101) gallbladder stones. Results: Biliary cholesterol concentration and CSI did not differ between patients with solitary o r multiple stones; however, it was positively correlated with the CSI (r = 0.93; p < 0.01). We found a negative correlation between CSI and TLC (r = - 0.77 for solitary stones and r = - 0.79 for multiple stones ; p < 0.01). Furthermore, levels of total bile acids and phospholipids were similar in cases with solitary and multiple gallbladder stones. TLC did not correlate with single or multiple stones, whereas NT was d etermined to be negatively correlated with the number of gallstones (r = - 0.39; p < 0.01). Patients with solitary stones had a significantl y (p < 0.01) longer NT than those with multiple gallbladder stones (7. 5 +/- 4.2 days versus 2.3 +/- 1.5 days). Conclusions: Our findings sug gest that there exists a nucleation-promoting activity, which seems to be more pronounced in patients with multiple gallbladder stones than in those with solitary stones, indicating a major risk factor for the higher recurrence rate seen in these patients.