The Effect of Biliary Sphincterotomy on Serum Cholesterol Levels in Postcholecystectomy Patients: A Pilot Study

BACKGROUND: Cholesterol, in the form of bile salts, is reabsorbed from the small intestine via the enterohepatic circulation. Biliary sphincterotomy increases the delivery of bile to the terminal ileum. If the absorptive capacity is exceeded, cholesterol excretion may increase, resulting in a decrease in serum cholesterol levels and improvement in serum lipid profiles.AIM: To determine the effect of biliary sphincterotomy on serum cholesterol levels in patients without biliary obstruction.PATIENTS AND METHODS: Postcholecystectomy patients with type III biliary sphincter of Oddi dysfunction (disabling pancreatobiliary-type pain with normal liver function tests and bile duct diameter) who underwent biliary sphincterotomy were identified retrospectively from the endoscopic retrograde cholangiopancreatography database. Baseline (pre-endoscopic retrograde cholangiopancreatography) laboratory investigations (including cholesterol) were obtained for all patients. The effect of sphincterotomy on total cholesterol levels was noted in all patients who returned for subsequent procedures (temporary pancreatic stent removal or evaluation of recurrent symptoms), and also in the subgroup of patients with baseline hypercholesterolemia (higher than 5.18 mmol/L).RESULTS: In the present pilot study, the performance of biliary sphincterotomy was associated with a reduction in total serum cholesterol levels in postcholecystectomy patients without biliary obstruction. This was statistically significant in patients with a baseline cholesterol level higher than 5.18 mmol/L. A possible effect on low-and high-density lipoprotein concentrations was not evaluated. The influence of dietary changes and exercise were not accounted for.CONCLUSION: A prospective, controlled study involving a larger series of patients is required to determine whether biliary sphincterotomy lowers cholesterol levels and improves lipid profiles.

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Faculty Opinions recommendation of Urgent endoscopic retrograde cholangiopancreatography is not superior to early ERCP in acute biliary pancreatitis with biliary obstruction without cholangitis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732604646.793546992 ◽

2018 ◽

Author(s):

Matthew DiMagno

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Biliary Obstruction ◽

Biliary Pancreatitis ◽

Endoscopic Retrograde ◽

Acute Biliary Pancreatitis

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Optimal timing of endoscopic retrograde cholangiopancreatography for acute cholangitis associated with distal malignant biliary obstruction

BMC Gastroenterology ◽

10.1186/s12876-021-01755-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Namyoung Park ◽

Sang Hyub Lee ◽

Min Su You ◽

Joo Seong Kim ◽

Gunn Huh ◽

...

Keyword(s):

Mortality Rate ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Biliary Obstruction ◽

Acute Cholangitis ◽

Mortality Rates ◽

Malignant Biliary Obstruction ◽

Optimal Timing ◽

Endoscopic Retrograde ◽

The Difference ◽

Distal Malignant Biliary Obstruction

Abstract Background There is a lack of studies regarding the optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in patients with cholangitis caused by distal malignant biliary obstruction (MBO). This study aims to investigate the optimal timing of ERCP in patients with acute cholangitis associated with distal MBO with a naïve papilla. Methods A total of 421 patients with acute cholangitis, associated with distal MBO, were enrolled for this study. An urgent ERCP was defined as being an ERCP performed within 24 h following emergency room (ER) arrival, and early ERCP was defined as an ERCP performed between 24 and 48 h following ER arrival. We evaluated both 30-day and 180-day mortality as primary outcomes, according to the timing of the ERCP. Results The urgent ERCP group showed the lowest 30-day mortality rate (2.2%), as compared to the early and delayed ERCP groups (4.3% and 13.5%) (P < 0.001). The 180-day mortality rate was lowest in the urgent ERCP group, followed by early ERCP and delayed ERCP groups (39.4%, 44.8%, 60.8%; P = 0.006). A subgroup analysis showed that in both the primary distal MBO group, as well as in the moderate-to-severe cholangitis group, the urgent ERCP had significantly improved in both 30-day and 180-day mortality rates. However, in the secondary MBO and mild cholangitis groups, the difference in mortality rate between urgent, early, and delayed ERCP groups was not significant. Conclusions In patients with acute cholangitis associated with distal MBO, urgent ERCP might be helpful in improving the prognosis, especially in patients with primary distal MBO or moderate-to-severe cholangitis.

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924 How Successful Is Endoscopic Retrograde Cholangiopancreatography in Patients With Biliary Obstruction Post-Pancreaticoduodenectomy?

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000593232.93611.91 ◽

2019 ◽

Vol 114 (1) ◽

pp. S540-S540

Author(s):

Osman Ahmed ◽

Phonthep Angsuwatcharakon ◽

Abraham Yu ◽

Seifeldin Hakim ◽

Emmanuel Coronel ◽

...

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Biliary Obstruction ◽

Endoscopic Retrograde

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Biliary Obstruction During Cholecystectomy: Endoscopic Retrograde Cholangiopancreatography, Evade, or Explore?

The American Surgeon ◽

10.1177/000313481107700815 ◽

2011 ◽

Vol 77 (8) ◽

pp. 985-991 ◽

Cited By ~ 1

Author(s):

Benjamin K. Poulose ◽

Kristy L. Kummerow ◽

William H. Nealon ◽

Julia S. Shelton ◽

Daniel R. Masys ◽

...

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Biliary Obstruction ◽

Common Bile Duct Exploration ◽

Biliary Complication ◽

Biliary Complications ◽

Research Database ◽

Endoscopic Retrograde ◽

Aggressive Approach ◽

Best Management ◽

Synthetic Derivative

Biliary obstruction discovered during cholecystectomy remains a challenging problem. To determine the best management, this retrospective study compared intervention during the same admission (SA) versus delayed/no intervention (DN). Furthermore, this study demonstrates the power of a deidentified research database derived from electronic medical records. Patients undergoing cholecystectomy and intraoperative cholangiogram (IOC) were identified in the Vanderbilt Synthetic Derivative database. Patients with biliary obstruction discovered during IOC were included and a cohort study was performed. Interventions for biliary obstruction included endoscopic retrograde cholangiopancreatography or common bile duct exploration. A composite measure of any biliary complication served as the primary outcome. A total of 1899 patients who underwent cholecystectomy were evaluated; 151 met inclusion criteria. Mean age was 44 years with 69 per cent women. Sixty-three per cent of patients had intervention during the SA for cholecystectomy compared with 37 per cent for DN. Nineteen per cent of patients in the SA group had biliary complications versus 16 per cent for DN ( P = 0.656). Patients in the SA group had a significantly increased length of stay (4.7 vs 2.1 days, P < 0.05). These data suggest an aggressive approach to biliary obstruction seen on IOC does not reduce postoperative biliary complications and may incur unnecessary resource use.

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