Article Text

Download PDFPDF
Effect of endoscopic sphincterotomy on gall bladder bile lithogenicity and motility
  1. B C Sharmaa,
  2. D K Agarwala,
  3. S S Baijalb,
  4. T S Negia,
  5. G Choudhuria,
  6. V A Saraswata
  1. aDepartment of Gastroenterology, bDepartment of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  1. Dr B C Sharma, Ho No 591, Sector 2, Panchkula, Haryana, India.


Background—Endoscopic sphincterotomy has been shown to inhibit stone formation in the gall bladder of experimental animals.

Aims—To investigate the alterations in bile composition and gall bladder motility after endoscopic sphincterotomy.

Patients—A 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)).

Methods—Gall 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.

Results—There 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 v14.7 (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/dlv 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 v23.4 (6.28) mmol/l) and bile acid (93.7 (7.31) mmol/l v105.07 (16.6) mmol/l) concentrations.

Conclusions—After endoscopic sphincterotomy there was enhanced contractility of the gall bladder, accompanied by a prolongation of nucleation time and reduction in cholesterol saturation index.

  • gall bladder emptying
  • gall bladder contractility
  • nucleation time
  • cholesterol saturation index
  • gallstones
  • endoscopic papillotomy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.