Quantitative cholescintigraphy and bile abnormalities in patients with acalculous biliary pain

Abstract

Acalculous biliary pain has been related to gallbladder dysfunction that produces a gallbladder emptying defect-a condition which favours the development of lithiasis. It is therefore probable that microlithiasis is present in patients with gallbladder dysfunction. The aims of this study were to measure gallbladder emptying and investigate bile abnormalities in patients with acalculous biliary pain. In 92 consecutive patients, gallbladder emptying was assessed by quantitative cholescintigraphy (abnormal ejection fraction < or =40%). In 64 patients, a microscopic study was performed on duodenal bile, defining abnormality as the presence of cholesterol crystals in any amount and/or calcium bilirubinate granules and/or microspheroliths at a rate of >10 per slide. The ejection fraction was abnormal in 45 patients (49%) (median 25.1%, range 6.8-39.3%) and normal in the remaining 47 cases (median 71.3%, range 41.0-96.1%). Bile was abnormal in 32 of 64 patients (50%), the most frequent finding being calcium bilirubinate granules. In the patients with bile abnormalities, abnormal ejection fraction was more frequent (20 of 32) and the median ejection fraction was lower (30.9%, range 12.0-94.1%) than in the patients with normal bile (16 of 32 with an abnormal ejection fraction; median ejection fraction 50.7%, range 6.8-96.1%). Abnormal bile was frequent (55.5%) in patients with reduced ejection fraction, but was not uncommon in patients with normal ejection fraction (33.3%). Fewer patients showed no alteration (25%). It is concluded that in most patients, acalculous biliary pain coexists with gallbladder dysfunction or abnormal bile, the combination of both alterations being common.

Is There an Association Between Gallbladder Dyskinesia and Idiopathic Acute Pancreatitis?

“…However, it has been suggested that microlithiasis not detected by the standard imaging techniques might be an etiological factor in a subset of patients with idiopathic acute pancreatitis [15,16]. Reduced ejection fraction of the gallbladder may lead to the formation of microlithia [17]. This study offers possible implications for the management of idiopathic acute pancreatitis.…”

Endoscopically Obtained Bile Aspirate is an Accurate Adjunct in the Diagnosis of Symptomatic Gallbladder Disease

“…The presence of microcrystals and white blood cells are the essentials of a “positive” duodenal aspirate analysis. 8,15,17,20,24,25,29–31 …”