Advertisement

Digestive Diseases and Sciences

, Volume 42, Issue 7, pp 1495–1500 | Cite as

Effect of Endoscopic Sphincterotomy on Gallbladder Motility

  • D. K. Agarwal
  • B. C. Sharma
  • R. K. Dhiman
  • S. S. Baijal
  • G. Choudhuri
  • V. A. Saraswat
Article

Abstract

In experimental animals, sphincterotomyfacilitates passage of solids from the gallbladder andinhibits gallstone formation apparently by improvementin gallbladder emptying. In humans, however, gallbladder emptying has not been studied followingendoscopic sphincterotomy (ES) in patients withgallstones. We therefore prospectively studied restingand cerulinstimulated gallbladder volumes by real timeultrasonography in 15 patients of choledocholithiasis withgallbladder in situ (eight with and seven withoutgallbladder calculi) before and after (after bile ductclearance) ES. ES significantly lowered restinggallbladder volume (21.2 ± 10.6 vs 11.1 ±5.0; P < 0.0001) and cerulin-stimulated residualgallbladder volume (10.8 ± 5.6 vs 4.4 ±2.1; P < 0.0001). ES also significantly increased thegallbladder ejection fraction (47.3 ± 12.1% vs 58.8 ± 11.1%; P < 0.0001). Therate constant for gallbladder emptying after cerulininfusion also increased significantly after ES(–0.022/min vs –0.031/ min; P < 0.0001).Significant improvement in gallbladder motility was observed in both groups ofpatients with and without gallbladder calculi. ESsignificantly improves gallbladder motility inhumans.

SPHINCTEROTOMY GALLBLADDER MOTILITY 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Hutton SW, Sievert CE Jr, Vennes JA, Duane WC: The effect of sphincterotomy on gallstone formation in the prairie dog. Gastroenterology 81:663–667, 1981Google Scholar
  2. 2.
    Hutton SW, Sievert CE Jr, Vennes JA, Duane WC: Inhibition of gallstone formation by sphincterotomy in the prairie dog: Reversal by atropine. Gastroenterology 82:1308–1313, 1982Google Scholar
  3. 3.
    Hutton SW, Sievert CE Jr, Vennes JA, Shafer RB, Duane WC: Spontaneous passage of glass beads from the canine gallbladder: Facilitation by sphincterotomy. Gastroenterology 94:1031–1035, 1988Google Scholar
  4. 4.
    Cotton PB, Vallon AG: Duodenoscopic sphincterotomy for removal of bile duct stones in patients with gallbladders. Surgery 91:628–630, 1982Google Scholar
  5. 5.
    Cotton PB: Endoscopic management of bile duct stones (apples and oranges). Gut 25:587–597, 1984Google Scholar
  6. 6.
    Tanaka M, Ikeda S, Yoshimoto H, Matsumoto S: The long-term fate of the gallbladder after endoscopic sphincterotomy. Am J Surg 154:505–509, 1987Google Scholar
  7. 7.
    Rosseland AR, Solhaug JH: Primary endoscopic papillotomy (EPT) in patients with stones in the common bile duct and the gallbladder in situ: A 5–8 year follow-up study. World J Surg 12:111–116, 1988Google Scholar
  8. 8.
    Siegel JH, Safrany L, Ben-Zvi JS, Pullano WE, Cooperman A, Stenzee M, Ramsey WH: Duodenoscopic sphincterotomy in patients with gallbladder in situ: Reports of a series of 1272 patients. Am J Gastroenterol 83:1255–1258, 1988Google Scholar
  9. 9.
    Tulassay Z, Papp J: Endoscopic sphincterotomy for common bile duct calculi. Gut 29:1295, 1988Google Scholar
  10. 10.
    Dodds WJ, Groh WJ, Darweesh RMA, Lawson TL, Kishk SMA, Kern MK: Sonographic measurement of gallbladder volume. AJR 145:1009–1011, 1985Google Scholar
  11. 11.
    Catnach SM, Fairclough PD, Trembath RC, O'Donnel JD, McLean AM, Penny AL, Wickham JEA: Effect of oral erythromycin on gallbladder motility in normal subjects and subjects with gallstones. Gastroenterology 102:2071–2076, 1992Google Scholar
  12. 12.
    Classen M, Demling L: Endoskopische sphinketerotomie der papill vateri und steinextraktion aus dern ductus choledochus. Dtsch Med Wochenschr 99:496–497, 1974Google Scholar
  13. 13.
    Everson GT, Braverman DZ, Johnson ML, Kern F Jr: A critical evaluation of real time ultrasonography for the study of gallbladder volume and contraction. Gastroenterology 79:40–46, 1980Google Scholar
  14. 14.
    Kaw M, Shiben T, Ahn J, Ravi T, Agrawal R, Brodmerkel G: Sphincter of oddi dysfunction (SOD) with intact gallbladder (IGB) and response to endoscopic sphincterotomy. Am J Gastroenterol 90:1608, 1995Google Scholar
  15. 15.
    Fisher RS, Stelzer F, Rock E, Malmud LS: Abnormal gallbladder emptying in a subgroup of patients with gallstones. Dig Dis Sci 27:1019–1024, 1982Google Scholar
  16. 16.
    Pomeranz IS, Shaffer EA: Abnormal gallbladder emptying in a subgroup of patients with gallstones. Gastroenterology 88:787–791, 1985Google Scholar
  17. 17.
    Gregg JA, Carr-Locke DL: Endoscopic pancreatic and biliary manometry in pancreatic, biliary, and papillary disease, and after endoscopic sphincterotomy and surgical sphinctero plasty. Gut 25:1247–1254, 1984Google Scholar
  18. 18.
    Ponce J, Sala T, Pertejo V, et al: Manometric evaluation of sphincter of Oddi after endoscopic sphincterotomy and in patients with previous surgical sphincterotomy. Endoscopy 15:249–251, 1983Google Scholar
  19. 19.
    Scott RB, Eidt PB, Shaffer EA: Regulation of fasting duode nal bile acid delivery by sphincter of Oddi and gallbladder. Am J Physiol 249:G22–G23, 1985Google Scholar
  20. 20.
    Desa LA, Grace PA, Henderson B, Thompson JN: Gallbladder function after endoscopic sphincterotomy. BMJ 300:1111, 1990Google Scholar
  21. 21.
    Chandramouli B, Gupta SM, Cohen GE: Scintigraphic evaluation of bile dynamics before and after endoscopic sphincterotomy. Clin Nucl Med 19:800–802, 1994Google Scholar
  22. 22.
    Worthley CS, Toouli J: Gallbladder nonfilling: An indication for cholecystectomy after endoscopic sphincterotomy. Br J Surg 75:796–798, 1988Google Scholar
  23. 23.
    Cohn MS, Schwartz SI, Faloon WW, Adams JT: Effect of sphincteroplasty on gallbladder function and bile composition. Ann Surg 189:317–321, 1979Google Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • D. K. Agarwal
  • B. C. Sharma
  • R. K. Dhiman
  • S. S. Baijal
  • G. Choudhuri
  • V. A. Saraswat

There are no affiliations available

Personalised recommendations