Duodenal bile examination in identifying potential non-responders to bile salt treatment and its comparison with gall bladder bile examination

Endoscopically obtained bile aspirate is an accurate adjunct in the diagnosis of symptomatic gallbladder disease

Endoscopically obtained bile aspirate was found to be an effective technique to identify patients with symptomatic gallbladder disease and negative diagnostic studies.

Objectives:

The experience of a single surgeon in a rural hospital over a 10-year period was analyzed with respect to the utilization of endoscopically obtained bile aspirates as an adjunct in the diagnosis of symptomatic gallbladder disease.

Methods:

A retrospective study of the author's entire cholecystectomy experience over a 10-year period with 641 patients was conducted to evaluate the utility of the bile aspirate in the preoperative selection of operative candidates and with respect to the ultimate pathologic diagnostic accuracy of the test.

Results:

Derivation of preoperative diagnosis via traditional standard means was possible in 479 patients. An endoscopically obtained positive bile aspirate was found in 162 additional patients who failed to have positive traditional diagnostic studies (acalculous gallbladder disease). Micro-pathology was determined to be present in 603 patients (94.07%). In 27 of the 38 negatives, there had been positive radiological studies (71%). In 11 of the 38, a positive preoperative bile aspirate had been obtained (28.9%). Of the 162 patients with a positive bile aspirate, 151 (93.21%) of the gallbladder specimens had confirmatory histologic analysis (92.1% confidence interval ± 3.95%).

Conclusion:

In patients with symptoms suggestive of clinical gallbladder disease and negative traditional diagnostic studies, the endoscopically obtained bile aspirate has been shown to be a highly reliable tool in establishing the diagnosis and is recommended as an aid in the appropriate selection of candidates who may benefit from cholecystectomy.

Human bile as a rich source of biomarkers for hepatopancreatobiliary cancers

Metabolic profiling of biofluids is emerging as an important area with a promising number of applications in clinical medicine, including early diagnosis of numerous diseases that normally remain silent until late in the progress of disease. While blood and urine are more often used to explore biomarkers that distinguish he healthy from disease conditions, human bile is emerging as a rich source of biomarkers specifically for the cancers of the liver (hepatocellular carcinoma), bile ducts (cholangiocarcinoma), gallbladder and pancreas. This is owing to the fact that metabolites linked to the pathways of tumor cell metabolism are rich in bile by virtue of its association or proximity to the pathological source. Recent methodological developments have enabled the identification of a number of bile metabolites that have links with hepatopancreatobiliary diseases. Investigations of human bile are also considered to help the biomarker discovery process in vitro and provide avenues for translational research in detecting and following dynamic variations of biomarkers in clinical settings using noninvasive approaches, such as in vivo magnetic resonance spectroscopy. This article reviews the current status and potential applications of human bile as a source of biomarkers, with emphasis on metabolites, for early detection of cancers associated with the hepatopancreatobiliary system.

Characteristics of gallbladder bile of infants and children

In the past, biliary lipids of infants and children were studied in duodenal aspirates. This study was performed on original bile aspirated from the gallbladder. The analysis of lipids in bile demonstrated a significantly lower total lipid content in the bile of infants than in children (3.3 g/dl vs. 9.1 g/dl). The most prominent difference was demonstrated in the bile salt concentration (43.2 mM vs. 126.7 mM) and thereafter in the phospholipid content. Infants had a shorter nucleation time and a higher cholesterol saturation index than did children. These results may explain the increased tendency of infants to produce sludge and gallstones during total parenteral nutrition.

Polarizing microscopy of partially dissolved gallstone powder: a simple technique for studying gallstone composition

A quick and reliable method for estimating the proportion of constituents of a stone may be useful in determining the prevalence of chemical type of gallstones in different geographic areas or ethnic groups. Chemical and infrared spectroscopy estimation facilities are not commonly available in many parts of the world and visual inspection may not be reliable for scientific purposes. To investigate whether identification of microcrystalline solids in partially dissolved stone powder could accurately predict the chemical nature of the gallstone we undertook a blind study on 40 samples of gallstones and compared our results with those of visual inspection and quantitative infrared spectroscopy. There were 29 cholesterol stones (mean cholesterol 83.4 +/- 7.5%), six intermediate cholesterol stones (mean cholesterol 48.0 +/- 21.2%) and five pigment stones (mean cholesterol 14.3 +/- 4.3%) as determined by quantitative infrared spectroscopy. Microscopic examination of partially dissolved gallstone powder in ethanol correctly identified all 29 cholesterol gallstones (sensitivity 100%, specificity 92%), four of six intermediate cholesterol stones (sensitivity 67%, specificity 100%) and all five pigment stones (sensitivity 100%, specificity 97%). It also detected microspheroliths of calcium carbonate in 14 of 16 calcium carbonate containing gallstones (sensitivity 88%, specificity 100%). The chemical grouping of stones on the basis of microscopic examination was correct in 37 (93%) of 40 samples and was especially useful in identifying 'intermediate' cholesterol stones which cannot be recognized by visual inspection. Thus microscopic examination of powdered gallstones appears to be a simple and reliable method of determining gallstone composition.