NONINVASIVE ESTIMATE OF BILE FLUX THROUGH THE GALLBLADDER IN HUMANS

Objective: The aim of this study was to assess whether a single noninv asive technique, ultrasonography, is able in vivo: 1) to evaluate the time-related patterns of gallbladder bile storage and emptying, and 2) to quantitate the amount of bile flux through the gallbladder (GB). M ethods: Healthy volunteers were submitted to the simultaneous assessme nt of gallbladder volume variations by frequent serial ultrasonographi c (US) measurements and of hepatic bile flow through the GB by quantit ative cholescintigraphy (QC) during continuous i.v. infusion of 99 mTc -HIDA. An ad hoc mathematical analysis of US GB volume measurements wa s used to estimate the amount of bile flux through the GB. The QC-deri ved measurements of the flux of hepatic bile through the GB was used t o substantiate the US-derived estimates. Results: The curves expressin g the time-related GB handling of hepatic bile obtained independently from US and QC measurements were statistically equivalent, and both te chniques showed that the patterns and the amount of hepatic bile handl ed by the gallbladder after meal ingestion is remarkably different dur ing three successive phases. After meals, hepatic bile was mainly 1) s tored in the GB in the first phase; 2) emptied from the GB in a second phase; and 3) stored in the GB in the third phase. The ultrasonograph ic analysis estimated that 1) 23.8 +/ 12.5 ml (0.44 +/- 0.11 ml/min), 5.1 +/- 3.9 ml (0.15 +/- 0.10 ml/min), and 33.2 +/- 10.5 ml (0.53 +/- 0.16 ml/min) of hepatic bile entered into the GB during the three succ essive postprandial phases, and 2) the entire amount of bile flowing b idirectionally through the cystic duct, during the observation period (132.6 +/- 23.3 ml) was about five-fold greater than that estimated by the usually employed variables. Conclusion: The proposed mathematical analysis of frequent ultrasonographic measurements of the GB volumes enables one to estimate noninvasively the flux of bile through the gal lbladder in humans. (Am J Gastroenterol 1998;93:1877-1885. (C) 1998 by Am. Cell. of Gastroenterology)