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The physical presence of gallstone modulates ex vivo cholesterol crystallization pathways of human bile

Gastroenterology Report 2019年第1期7卷 32-41,I0002页

作者： Piero Portincasa Karel Jvan Erpecum Agostino Di Ciaula David Q-H.Wang Division of Internal Medicine Department of Biomedical Sciences and Human OncologyUniversity Medical SchoolBariItaly Department of Gastroenterology University Medical CenterUtrechtThe Netherlands Division of Internal Medicine Hospital of BisceglieASL BATBisceglieItaly Department of Medicine Division of Gastroenterology and Liver DiseasesMarion Bessin Liver Research CenterAlbert Einstein College of MedicineBronxNYUSA

Background:Cholesterol crystallization is an essential step toward gallstone *** model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cholesterol molecules available for crystallization,this has not been investigated in human ***:Fresh gallbladder bile was obtained during laparoscopic cholecystectomy from 13 patients with cholesterol(n紏10)or pigment(n紏3)*** cholesterol gallstones were collected from another two *** native and ultrafiltered bile with or without added gallstones was analysed by polarized light microscopy for the presence of arc-like and needle-like anhydrous cholesterol crystals and classic cholesterol monohydrate *** of the added stones was evaluated before and after 21 days of bile ***:In unfiltered bile,the presence of stones was associated with a trend towards less anhydrous cholesterol crystals,but significantly more aggregated cholesterol monohydrate *** ultrafiltered bile,the presence of stones tended to inhibit the formation of arc-like or needle-like crystals and was associated with significantly greater amounts of both platelike and aggregated cholesterol monohydrate *** 21 days of the incubation,stone weight was decreased in both unfiltered(–4.561.6%,P紏0.046)and ultrafiltered bile(–6.561.5%,P紏0.002).Bile from pigment-stone patients was clear in the absence of stones,but showed early appearance of plate-like and aggregated cholesterol monohydrate crystals in all samples to which cholesterol gallstones were ***:The physical presence of cholesterol gallstones in both native and filtered bile greatly influences cholesterol crystallization *** cholesterol monohydrate crystals increase,anhydrous cholesterol crystals tend to be *** of solid cholesterol crystals from the gallstone surface may explain these findings.

关键词： Bile cholesterol crystals cholesterol stones pigment stones polarizing light microscopy supersaturated bile

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Relationship between intraduodenal peri-ampullary diverticulum and biliary disease in 178 patients undergoing ERCP

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Hepatobiliary & Pancreatic Diseases International 2007年第3期6卷 299-302页

作者： Wu, Shuo-Dong Su, Yang Fan, Ying Zhang, Zhen-Hai Wang, Hao-Lin Kong, Jing Tian, Yu China Med Univ Dept Gen Surg Affiliated Hosp 2 Shenyang 110004 Peoples R China

BACKGROUND: The presence of intraduodenal periampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers in China and overseas reported that the diverticulum had something to do with the incidence of cholelithiasis. This study was undertaken to further test this notion and ascertain the relationship between intraduodenal periampullary diverticulum and biliary disease, especially the formation of bile duct pigment stones. METHODS: A total of 178 patients who had undergone ERCP or endoscopic sphincterotomy (EST) were studied retrospectively. They were divided into 6 groups according to the category of biliary disease, and the incidence rates of intraduodenal peri-ampullary diverticulum were calculated. duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inflammation and stricture of the end of the bile duct and papilla, and patients with carcinoma of the end of the bile duct and papilla. These findings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones. RESULTS: There were 44 patients with intraduodenal periampullary diverticulum in 81 patients with primary bile duct pigment stones (54.32%), 4 in 8 patients with bile duct stones and gallbladder stones (50%), 7 in 33 patients with bile duct stones secondary to gallbladder stones (21.21%), 3 in 21 patients with inflammation and stricture of the end of the bile duct and papilla (14.29%), 1 in 22 patients with carcinoma of the end of the bile duct and papilla (4.54%), and 5 in 13 patients with post-cholecystectomy syndrome or sphincter of Oddi dysfunction (38.46%). CONCLUSIONS: The incidence rate of intraduodenal periampullary diverticulum in patients with primary bile duct pigment stones is higher than that in patients with bile duct stones secondary to

关键词： intraduodenal peri-ampullary diverticulum pigment stones endoscopic retrograde cholangiopancreatography sphincter of Oddi

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