Effect of Endoscopic Sphincterotomy on Bile Lithogenicity in Patients with Gallbladder In Situ

Introduction

Endoscopic sphincterotomy is widely employed to remove common bile duct stones. This procedure is used in patients with residual lithiasis who have undergone cholecystectomy, and in patients with an intact gallbladder who have high operative risks. Cholestasis, which is associated with choledocholithiasis, induces an accumulation of bile acids in the liver. A large concentration of hydrophobic bile acids in the hepatocytes significantly reduces cholesterol catabolism [1] via a down-regulation of the 7-α-hydroxylase activity [2] [3]. Moreover, during cholestasis bile salt secretion is low and the relative proportions of bile salts, lecithin, and cholesterol in bile can result in the formation of highly cholesterol-supersaturated hepatic bile [4].

Many studies have focused on the lithogenicity of bile as a consequence of excessive cholesterol secretion [5] [6], but few have investigated the effect of endoscopic sphincterotomy on biliary cholesterol secretion [7]. Data are scarce concerning the modifications in biliary lipid composition induced by the ablation of the sphincter of Oddi in humans with gallbladder in situ. Sauerbruch et al. [8] demonstrated that sphincterotomy reduced the bile salt pool size in patients with an intact gallbladder, and that this reduction did not increase the degree of cholesterol saturation in hepatic bile. Recently, Dhiman et al. [9] reported that sphincterotomy decreases the lithogenicity of human bile, as reflected by the prolongation of cholesterol nucleation time.

Our study was aimed at establishing the influence of endoscopic sphincterotomy on bile composition. Specifically, the cholesterol saturation index and the bile acid pattern were determined in the gallbladder bile of lithiasis patients with an intact sphincter of Oddi, in the hepatic bile of patients with gallbladder in situ checked 3 months after the endoscopic procedure, and in the gallbladder bile of patients who had previously undergone sphincterotomy and who were undergoing cholecystectomy.

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