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Chin Med J (Taipei) 1998;61:S95.

Biliary Motility in Patients After Endoscopic Sphincterotomy

Kwok-Hung Lai, Jia-Sheng Huang, Nan-Jing Peng1, Wen-Yi-Tseng, Jin-ShiuGin-Ho Lo, Chiun-Ku Lin. Ping-I Hsu.

Department of Internal Medicine and Nuclear Medicine1
Veterans General Hospital-Kaohsiung
Kaohsiung, Taiwan, R.O.C.

Abstract

Background. Endoscopic sphincterotomy (EST) is now widely used for the removal of common bile duct stones (CBDS). After EST, the recurrent CBDS has been reported as high as 24%, and subsequent cholecystectomy in patient with intact gallbladder ranges from 10-22%. The change in gallbladder function after EST is still controversial and the biliary emptying after EST is rarely discussed. In this study, we used the fatty meal sonography and quantitative cholecystectomy to evaluate the function of biliary tract in patients after EST, and found out the relationship between the biliary motility and late complication of EST.

Methods. From Sept 1990 to May 1994, 149 patients who had received EST to remove CBDS, were regularly followed in Veterans General Hospital-Kaohsiung. They received endoscopic sphincter of Oddi manometry(SOM) to confirm complete sphincterotomy (basal pressure < 10mmHg, in addition to wide opening of major papilla) after normalization of liver function, and quantitative cholescintigraphy (QC) was also performed within one week after SOM. Thereafter, all patients were regularly interviewed and received biochemical tests every 3 to 6 months. Abdominal sonography and endoscopic retrograde cholanglography were done in patients with abnormal liver function tests or recurrent symptoms. Twenty three patients with intact gallbladder and seven normal volunteers were also received fatty meal sonography to evaluate their gallbladder function.

Results. After EST, 62.5 % of patients were found to have normal filling of gallbladder in QC, only 37.5% of patients had delayed or non-filling of gallbladder. In the 23 patients with intact gallbladder, the fasting volume of gallbladder was not significantly different with normal volunteers (30.4 +/- 3.6ml vs. 33.6 +/- 4.7ml). After fatty meal, patients who had received EST, had higher ejection fraction ( 85 +/- 15% vs. 58 +/- 14%, P < 0.05) and shorter maximal gallbladder emptying time (11 +/- 3 min vs. 32 +/- 6 min, p < 0.05) than normal volunteers . During the median 36 months (range 13-61 months) follow up, 22 patients had recurrent CBDS. In the patients with recurrent CBDS, the 45 minutes clearance of radioisotope E45' in QC was lower than the patients without recurrent stones (35.9 +/- 4.5% vs. 54.6 +/- 1.8%, P < 0.001 in cholecystectomized patients, 37.0 +/- 5.2% vs. 46.9 +/- 2.4%, p = 0.09, in patients with intact gallbladder). In multivariate analysis, only the E45' was the siginificant factor related to the recurrent CBDS.

Discussions 1. Gallbladder function is still intact in 62.5% of patients after EST. 2. Endoscopic sphincterotomy may facilitate the gallbladder emptying. 3. Recurrent CBDS may occur in patients with slower billary emptying. 4. Close follow-up is needed in those patients with abnormal QC.

[Chin Med J (Taipei) 1998;61:S95.]

Copyright: 1998, Chinese Medical Association (Taipei)