The effect of endoscopic sphincterotomy in patients with acalculous biliary type pain and impaired caerulein-induced gallbladder ejection fraction – preliminary results

Introduction: Impaired gallbladder (GB) ejection fraction (GBEF) in patients (pts) with acalculous biliary type pain (ABP) is a commonly accepted phenomenon and most of these pts usually undergo cholecystectomy. The aim of our study is to evaluate the effect of endoscopic sphincterotomy (EST) in pts with ABP and impaired caerulein-induced GBEF.

Patients and methods: 17 consecutive patients with right upper quadrant abdominal pain and without any organic disease/normal laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasonography (US)/were enrolled until the end of February 2006. After an overnight fast 1 ng/bwkg/min caerulein (CCK10) was infused for 10min for all pts intravenously and the GB diameters were determined with US in the 0. 10. 20. and 30. min. and the GBEF was calculated. The examination was repeated in a 2-day-period with 0.5mg sublingually administered gliceryl-trinitrate (GTN) pre-treatment. The pts were divided into two groups:10 pts had normal (Group I.) but 7 had impaired (<40%) caerulein-induced GBEF (Group II.). In group II. EST was performed in all pts after the US examinations. 3 months after the EST the measurement of the GBEF was repeated.

Results: In group II, before the EST the GBEF was 20.6±5.1% vs. 65.3±11.4% in group I (p=3.4 10–7). The GTN pre-treatment significantly increased the GBEF in all pts in group II (52±14.7%, p=3.3 10–3) but was not effective in Group I (70.2±17.4, p=4.2 10–1). The EST normalized the GBEF in all but one pts (52±10.7%, p=8.4 10–3) and their symptoms decreased.

Conclusion: In a subgroup of pts with ABP and impaired caerulein-induced GBEF, EST could normalize the GB function and alleviate symptoms. GTN augmentation could help to select those pts, who could benefit from EST.