Editor,—We read with interest the article by Sugiyama and Atomi (Gut1996;39:856–9) on the effect of endoscopic sphincterotomy (ES) on gall bladder motility. These authors have proved conclusively that ES causes a significant improvement in gall bladder motility in humans. We have assessed gall bladder motility in patients who underwent ES for common bile duct (CBD) stones and compared these with patients with gall bladder calculi but without CBD stones. We found significantly lower fasting and residual gall bladder volumes in the patients who had undergone ES, indicating reduced filling after ES.1 However, the ejection fraction and the rate constant of gall bladder emptying in these patients was increased significantly, suggesting increased gall bladder emptying. In another study2 we found a significant decrease in fasting volume (mean (SD) 18.3 (8.5) v 13.9 (7.3) ml), residual volume (12.0 (8.0) v 4.4 (3.2) ml) and an increase in the ejection fraction (54.3 (9.8)v 83.5 (5.4)) after ES, suggesting decreased stasis and increased gall bladder emptying.

In Sugiyama and Atomi’s this study, all patients in whom gall bladder motility was assessed before ES had CBD stones; all stones were extracted before …

Dr Sugiyama.