Effect of endoscopic sphincterotomy on gall bladder bile lithogenicity and motility

B C Sharma,^a D K Agarwal,^a S S Baijal,^b T S Negi,^a G Choudhuri,^a V A Saraswat^a

^a Department of Gastroenterology, ^b Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Correspondence to: Dr B C Sharma, Ho No 591, Sector 2, Panchkula, Haryana, India.

Accepted for publication 31 July 1997

BackgroundEndoscopic sphincterotomy has been shown to inhibit stone formation in the gall bladder of experimental animals.
AimsTo investigate the alterations in bile composition and gall bladder motility after endoscopic sphincterotomy.
PatientsA study was performed of gall bladder bile composition and gall bladder motility in patients with gallstone disease ((n = 20; age 40-60 years, median age 55 years: seven men), 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 and sex matched disease controls comprised 20 patients with gallstone disease but without stones and an intact sphincter of Oddi (with gall bladder calculi (n = 10) and diseased gall bladder without gall bladder calculi (n = 10)).
MethodsGall bladder motility was assessed by ultrasound. Duodenal bile collected by nasoduodenal tube after stimulation of gall bladder by intravenous ceruletid infusion was analysed for cholesterol, phospholipid, and bile acid concentrations, cholesterol saturation index, and nucleation time.
ResultsThere was a significant reduction in 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) ml; 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 subjected to endoscopic sphincterotomy. Median nucleation time was significantly longer (17 days v 6 days; p<0.006) in treated patients. There was a reduction in total mean (SEM) lipid concentrations (6.73 (0.32) g/dl v 7.72 (0.84) g/dl; p<0.05), cholesterol (5.6 (1.5) mmol/l v 10.3 (2.23) mmol/l; p<0.001) and CSI (0.72 (0.15) v 1.32 (0.31); p<0.001). 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.
ConclusionsAfter endoscopic sphincterotomy there was enhanced contractility of the gall bladder, accompanied by a prolongation of nucleation time and reduction in cholesterol saturation index.
(GUT 1998;42:288-292)

Keywords: gall bladder emptying;  gall bladder contractility;  nucleation time;  cholesterol saturation index;  gallstones;  endoscopic papillotomy