Does a fatty meal improve hepatic clearance in patients after endoscopic sphincterotomy?
BACKGROUND
Delayed biliary emptying is a cause of recurrent bile duct stones in patients after endoscopic sphincterotomy (ES) for choledocholithiasis. This study aimed to evaluate the effect of fatty meal on hepatic clearance in patients after ES.


METHODS
Sixty patients who had received ES and complete clearance of bile duct stones were enrolled. Delayed hepatic clearance (45 min clearance of radioisotope [E45'] < 57%) from quantitative cholescintigraphy (QC) and absence of sphincteric function confirmed by sphincter of Oddi manometry were found in each patient after normalization of liver function. Patients then received another QC 30 min after a fatty meal (two fried eggs and 250 mL full milk, fat 28 g) within 2 months.


RESULTS
Improvement of hepatic clearance in QC after fatty meal was found in 20 of 24 (83%) cholecystectomized patients and 27 of 36 (75%) patients with intact gallbladder. The E45' after fatty meal was significantly higher than that without fatty meal (56 +/- 12%vs 40 +/- 9% in cholecystectomized patients, P < 0.001; 52 +/- 16%vs 35 +/- 11% in patients with intact gallbladder, P < 0.001). All patients tolerated the fatty meal well during fatty meal QC.


CONCLUSIONS
Fatty meal can improve hepatic clearance in both patients with intact gallbladder and after cholecystectomy, so routine restriction of fat after ES may be inappropriate. However, further studies are needed to evaluate the role of diet in the prevention of recurrent biliary complications.
Lai
Kwok-Hung
KH
Department of Internal Medicine, Kaohsiung Veterans General Hospital, School of Medicine, National Yang Ming University, Taiwan, ROC. khlai@isca.vghks.gov.tw
Peng
Nan-Jing
NJ
Lo
Gin-Ho
GH
Lin
Chiun-Ku
CK
Chan
Hoi-Hung
HH
Hsu
Ping-I
PI
Cheng
Jin-Shiung
JS
Wang
Ya-Yu
YY
D004041:Dietary Fats; D042882:Gallstones / Q000601:surgery; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000502:physiology*; D011877:Radionuclide Imaging; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic; D013997:Time Factors
D004041:Dietary Fats