Impact of food on hepatic clearance of patients after endoscopic sphincterotomy.
BACKGROUND
The recurrence rate of common bile duct stones (CBDS) is around 3-21% after treatment by endoscopic sphincterotomy (ES). Fatty meal has been shown to improve hepatic clearance in both patients with intact gallbladder and post-cholecystectomy after ES. This study tested the effects of different kinds of food on hepatic clearance by using quantitative cholescintigraphy (QC) in patients after ES.


METHODS
Forty-seven patients after ES with abnormal QC were enrolled in our study. Complete ablation of sphincter function was confirmed by sphincter of Oddi manometry. Fasting QC was done in every patient shortly after normalization of liver function, and then followed with low-fat and fatty-meal QC. Each of the 47 subjects was observed for the effect on hepatic clearance at 3 different levels of treatments (diets and fasting). Additionally, possible factors responsible for recurrent CBDS were investigated by means of logistic regression.


RESULTS
Both fatty and low-fat meals could significantly improve hepatic clearance compared with fasting in most patients after ES. But the response to food types was individualized. All patients tolerated the meals well. There was no significant relationship between the recurrence of CBDS and sex, age, intact gallbladder and presence of juxtapapillary diverticulum, CBD size, and improvement in hepatic clearance (> or = 5%) by food.


CONCLUSIONS
Both fatty and low-fat meals improved hepatic clearance in most of the patients with CBDS after ES, but the response to meals was individualized. Therefore, there is no need to restrict the amount of fat intake for patients who have undergone ES.
Chan
Hoi-Hung
HH
Division of Gastroenterology, Kaohsiung Veterans General Hospital, Kaohsiung; National Yang-Ming University School of Medicine, Taipei; and Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan, R.O.C.
Lai
Kwok-Hung
KH
Lin
Chiun-Ku
CK
Tsai
Wei-Lun
WL
Peng
Nan-Jing
NJ
Hsu
Ping-I
PI
Lo
Gin-Ho
GH
Wei
Min-Ching
MC
Wang
E-Ming
EM
Chang
Hsueh-Wen
HW
D000328:Adult; D000368:Aged; D004041:Dietary Fats / Q000008:administration & dosage*; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000378:metabolism*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D011877:Radionuclide Imaging; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic
D004041:Dietary Fats