GALLBLADDER MOTILITY AND LITHOGENICITY OF BILE IN PATIENTS WITH CHOLEDOCHOLITHIASIS AFTER ENDOSCOPIC SPHINCTEROTOMY

Background/Aims: Ablation of the sphincter of Oddi has been shown to i nhibit gallstone formation in the prairie dog model, probably by allev iating gallbladder bile stasis, The effect of endoscopic sphincterotom y (ES) on gallbladder emptying and lithogenicity of bile has not been studied adequately in humans, We, therefore, studied the changes in ga llbladder emptying and lithogenicity of bile following ES in patients with choledocholithiasis and gallbladder in situ. Methods: Thirteen pa tients with choledocholithiasis with intact gallbladder underwent ES a nd common bile duct clearance, Eight patients had concomitant gallston es, Gallbladder emptying was studied by real time ultrasonography afte r stimulation by ceruletid infusion, Easting gallbladder bile was coll ected during endoscopic retrograde cholangiography by placing a 7F or 8F catheter in the common bile duct and after ceruletid stimulation of gallbladder for bile microscopy and cholesterol nucleation time deter mination, Gallbladder emptying, nucleation time and bile microscopy we re performed before ES and again between 4 and 8 weeks after ES after cholangiographic confirmation of clearance of common bile duct stones. Results: Easting and residual gallbladder volumes decreased and eject ion fraction increased significantly following ES, suggesting decrease d stasis and improved emptying of gallbladder. Nucleation time was pro longed and cholesterol crystal index in bile decreased after ES, sugge sting decreased lithogenicity, The decrease in gallbladder volumes and increase in ejection fraction after ES were observed in both groups o f patients, with or without concomitant gallstones. Conclusions: ES de creases the stasis of gallbladder bile, improves gallbladder emptying and decreases the lithogenicity of bile in patients with gallstone dis ease as reflected by prolongation in nucleation time, ES may find a ro le as an adjunct to oral bile acid therapy and extracorporeal shock wa ve lithotripsy in addition to a prophylactic role of preventing gallst one formation in high risk groups.