Premium
Small gallstones, preserved gallbladder motility, and fast crystallization are associated with pancreatitis
Author(s) -
Venneman Niels G.,
Renooij Willem,
Rehfeld Jens F.,
vanBergeHenegouwen Gerard P.,
Go Peter M. N. Y. H.,
Broeders Ivo A. M. J.,
van Erpecum Karel J.
Publication year - 2005
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.20616
Subject(s) - gallstones , gastroenterology , gallbladder , medicine , cholecystectomy , postprandial , pancreatitis , hepatology , biliary tract , insulin
Acute pancreatitis is a severe complication of gallstones with considerable mortality. We sought to explore the potential risk factors for biliary pancreatitis. We compared postprandial gallbladder motility (via ultrasonography) and, after subsequent cholecystectomy, numbers, sizes, and types of gallstones; gallbladder bile composition; and cholesterol crystallization in 21 gallstone patients with previous pancreatitis and 30 patients with uncomplicated symptomatic gallstones. Gallbladder motility was stronger in pancreatitis patients than in patients with uncomplicated symptomatic gallstones (minimum postprandial gallbladder volumes: 5.8 ± 1.0 vs. 8.1 ± 0.7 mL; P = .005). Pancreatitis patients had more often sludge (41% vs. 13%; P = .03) and smaller and more gallstones than patients with symptomatic gallstones (smallest stone diameters: 2 ± 1 vs. 8 ± 2 mm; P = .001). Also, crystallization occurred much faster in the bile of pancreatitis patients (1.0 ± 0.0 vs. 2.5 ± 0.4 days; P < .001), possibly because of higher mucin concentrations (3.3 ± 1.9 vs. 0.8 ± 0.2 mg/mL; P = .04). No significant differences were found in types of gallstones, relative biliary lipid contents, cholesterol saturation indexes, bile salt species composition, phospholipid classes, total protein or immunoglobulin (G, M, and A), haptoglobin, and α‐1 acid glycoprotein concentrations. In conclusion , patients with small gallbladder stones and/or preserved gallbladder motility are at increased risk of pancreatitis. The potential benefit of prophylactic cholecystectomy in this patient category has yet to be explored. (H EPATOLOGY 2005.)