title: The effect of biliary sphincterotomy on serum cholesterol level in postcholecystectomy patients: a pilot study.
abstract: 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.
  
  
  OBJECTIVE
  To determine the effect of biliary sphincterotomy on serum cholesterol levels in patients without biliary obstruction.
  
  
  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.
  
  
  CONCLUSIONS
  A prospective, controlled study involving a larger series of patients is required to determine whether biliary sphincterotomy lowers cholesterol levels and improves lipid profiles.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University Medical Center, 550 North University Boulevard, Indianapolis, IN 46202, USA. walazmi@gmail.com
authors.forename: Waleed M
authors.initials: WM
authors.lastname: Alazmi
authors.forename: Evan L
authors.initials: EL
authors.lastname: Fogel
authors.forename: James L
authors.initials: JL
authors.lastname: Watkins
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D008102:Liver Circulation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011184:Postoperative Period; D016717:Sphincterotomy, Endoscopic
chemical_list: D002784:Cholesterol