Abstract.
Ileal bypass and cholecystostomy are used in children with selected cholestatic diseases to lower the bile acid (BA) levels in bile and blood and improve outcome. The efficacy of a cholecystocolic bypass in achieving the same goals was investigated in guinea pigs. In the study group (n=7), a cholecystocolic bypass was performed using a jejunal graft interposed between the gallbladder and the cecum. In the control group (n=5), a cholecystojejunal bypass was performed with a similar graft implanted in the proximal jejunum. Total BA concentration was measured in bile and portal blood at surgery (D0) and 30 days later (D30) by pooling the concentrations of 7 individual BA. D30/D0 BA ratios were compared. All animals developed normally without clinical symptoms. A 76% reduction in the bile T-BA levels was observed in both groups (p<0.05). A 80% decrease of T-BA levels was observed in portal vein in study group (p<0.05), suggesting that ileal bile flow and BA ileal reabsorption were highly impaired. No change in portal vein BA levels was observed in control group. Cholecystocolic bypass led to a significant loss of bile acids in guinea pigs and might be considered for bile diversion in pediatric patients with selected cholestatic diseases.
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This work was supported by a grant from the Mediterranean Association for Organ Transplantation in Children, Marseille, France.
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Delarue, A., Gerhardt, M.F., Merrot, T. et al. The cholecystocolic bypass with jejunal interposition graft for bile acid depletion in bile and portal blood in guinea pigs. Ped Surgery Int 19, 371–375 (2003). https://doi.org/10.1007/s00383-003-1013-6
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DOI: https://doi.org/10.1007/s00383-003-1013-6