An attempt was made to evaluate the diagnostic effectiveness of the ¹⁴CO₂-tripalmitin breath test in the screening or diagnosis of fat malabsorption. The differential absorption of ¹⁴C-tripalmitin and palmitic acid was evaluated in the diagnosis of pancreatic insufficiency. 24 controls, 13 patients with steatorrhea and 6 with pancreatic disease (4 of them with insufficiency) were studied. 81 breath tests were performed using 75 ml sour cream as a carrier. In 11 cases the ¹⁴C-tripalmitin test was repeated using 27 g corn oil as carrier. Both the ¹⁴C-tripalmitin and ¹⁴C-palmitic acid breath tests failed to provide any discrimination between normals and patients with fat malabsorption. Variation in type and amount of the carrier fat did not alter these results. ¹⁴C-tripalmitin absorption was distinctly abnormal in the patients with pancreatic insufficiency. The differential absorption of ¹⁴C-tripalmitin and ¹⁴C-ρalmitic acid provided an even better separation between patients with and without pancreatic disease. In contrast to some other investigators we did not find the ¹⁴C-tripalmitin and/or palmitic acid breath tests useful in the diagnosis or screening of fat malabsorption. These tests appear promising in the diagnosis of pancreatic disease.

The cholyl glycine-1-¹⁴C breath test was evaluated in a variety of gastrointestinal disorders. 138 tests were performed in 106 patients. Methods of data expression were evaluated and the cumulative 8-hour value was used. In 27 control patients the upper limit of the normal was found to be 78. A good correlation was found between the peak values and the cumulative 8-hour values (r = 0.95, p < 0.01). The reproducibility of the test was good (r = 0.985, p < 0.05). Abnormal results were found in 12 out of 13 cases with resection of the ileum and 11 out of 14 cases with Crohn’s disease of the distal small bowel. The test was normal in cases with diseases of the proximal small bowel (celiac, Whipple’s and Crohn’s diseases). The test was also normal in patients with colitis. It was abnormal in some of the cases after cholecystectomy and in most cases with carcinoma of the pancreas. The breath test was useful in monitoring the results of treatment in bacterial overgrowth of the small bowel. False negative results were observed after antibiotic treatment. The method seems to be more sensitive than the Schilling test in diagnosing disease of the distal small bowel.

Aim: To compare gallstones removal rate and incidence of bleeding, pancreatitis, use of mechanical lithotripsy, cholangitis and perforation between isolated sphincterotomy versus sphincterotomy associated with balloon dilation of papilla in choledocholithiasis through the meta-analysis of randomized clinical trials. Methods: We conducted a systematic review according to the PRISMA guidelines. Literature search was restricted to randomized controlled trials (RCTs) on MedLine, Cochrane Library, LILACS, and EMBASE database platforms in July 2017. Eligibility criteria: Participants: patients with choledocholithiasis, older than 18 years. Interventions and comparisons: to compare endoscopic isolated sphincterotomy vs endoscopic sphincterotomy associated with balloon dilation. All relevant articles were accessed in full text. The manual search included references of retrieved articles. We extracted data focusing on outcomes: The primary endpoint was the stones removal rate; Secondary endpoints were rates of pancreatitis, bleeding, use of mechanical lithotripsy (ML), perforation and cholangitis. We analyzed the data and reported the results in tables and text. Results: Nine RCTs with a total of 1230 patients were included. Data analysis of the included studies showed that there was no statistical difference in safety between the two methods, since the incidence of pancreatitis (FE RD -0.01, CI [-0.03, 0.02], I 2 Z 0, p Z 0.5), bleeding (FE RD -0.01, CI [-0.03, 0.01], I 2 Z 32%, p Z 0.25), cholangitis (FE RD 0.00, CI[-0.01, 0.01], I 2 Z0, p Z 0.98) and perforation (FE RD -0.01, CI [-0.02, 0.01], I 2 Z0, p Z 0.37) was similar between the groups, but it was evident that there was a difference in efficacy, not quantitatively, with similar removal rates of gallstones in general and for subgroups greater than 15mm (FE RD 0.01, CI [-0.02, 0.04], I 2 Z 0, p Z 0.59) and (FE RD 0.02, CI [-0.04, 0.07], I 2 Z 5%, p Z 0.52), respectively, but perhaps qualitative, since there was less need for mechanical lithotripsy in the ESBD group (RE RD -0.14, CI [-0.25, -0.03], I 2 Z 91%, p Z 0.01), with a consequent theoretical decrease in exposure to adverse events resulting from it. Conclusion: There was no difference in the stone removal rate and incidence of bleeding, pancreatitis, cholangitis and perforation between isolated sphincterotomy and sphincterotomy associated with balloon dilation in the approach to remove gallstones. However, there was less use of mechanical lithotripsy in patients with choledocholithiasis submitted to sphincterotomy associated with balloon dilation.