EFFECT OF ENDOSCOPIC SPHINCTEROTOMY ON GALL-BLADDER BILE LITHOGENICITY AND MOTILITY

Background-Endoscopic sphincterotomy has been shown to inhibit stone f ormation in the gall bladder of experimental animals. Aims-To investig ate the alterations in bile composition and gall. bladder motility aft er endoscopic sphincterotomy. Patients-A study was performed of gall b ladder bile composition and gall bladder motility in patients with gal lstone disease ((n = 20; age 40-60 years, median age 55 years: seven m en), with gall bladder calculi (n = 12) and with diseased gall bladder (chronic inflammation) without gall bladder calculi (n = 8)), who had received endoscopic sphincterotomy for common bile duct stones. age a nd sex matched disease controls comprised 20 patients with gallstone d isease but without stones and an intact sphincter of Oddi (with gall b ladder calculi (n = 10) and diseased gall bladder without gall bladder calculi (n = 10)). Methods-Gall bladder motility was assessed by ultr asound. Duodenal bile collected by nasoduodenal tube after stimulation of gall bladder by intravenous ceruletid infusion was analysed for ch olesterol, phospholipid, and bile acid concentrations, cholesterol sat uration Index, and nucleation time. Results-There was a significant re duction ire mean (SEM) fasting volume (12.5 (1.7) ml v 26.4 (2.5) ml; p<0.001) and mean (SEM) residual volume (4.34 (0.9) ml v 14.7 (0.98) m l; p<0.001), and increase in mean (SEM) ejection fraction (65.7 (4.2)% v 43.6 (5.52)%; p<0.001) and mean (SEM) rate constant of gall bladder emptying (-0.031/min v -0.020/min; p<0.01) in patients who had been s ubjected to endoscopic sphincterotomy. Median nucleation time was sign ificantly longer (17 days v 6 days; p<0.006); in treated patients. The re was a reduction in total mean (SEM) lipid concentrations (6.73 (0.3 2) g/dl v 7.72 (0.84) g/dl; p<0.05), cholesterol (5.6 (1.5) mmol/l v 1 0.3 (2.23) mmol/l; p<0.001) and csi (0.72 (0.15) v 1.32 (0.31); p<0.00 1). There was no significant change in mean (SEM) phospholipid (25.6 ( 3.5) mmol/l v 23.4 (6.28) mmol/l) and bile acid (93.7 (7.31) mmol/l v 105.07 (16.6) mmol/l) concentrations. Conclusions-After endoscopic spi ncterotomy there was enhanced contractility of the gall bladder, accom panied by a prolongation of nucleation time and reduction in cholester ol saturation index.