Bile dynamics in patients with postcholecystectomy syndrome

BACKGROUND: Twenty-three cholecystectomized patients, asymptomatic or with recurrent biliary pain, were studied. METHODS: Six patients were asymptomatic without organic complications of the biliary tree and negative cholestasis laboratory tests; six were symptomatic with gallstones or stenosis of the main biliary tree; eleven patients were symptomatic without organic diseases. All the groups of patients were matched for age and sex. The filling and emptying kinetics of the biliary tree were studied by sequential cholescintigraphy with trimetil-Br-IDA 99mTc and computized gamma-camera. The exam was performed for sixty minutes during fast and for sixty minutes after a standard cholecystokinetic meal. RESULTS: Hepatic clearance time of the compound, filling and emptying of the biliary tree were significantly longer in patients with organic obstruction than in the other groups. The differences between controls and patients with anorganic diseases were otherwise not significative. CONCLUSIONS: In conclusion: 1) in cholecystectomized patients the recurrent biliary pain is likely present independently of alterations of the biliary wash-out; 2) sequential cholescintigraphy is a very good method, as well as endoscopic procedures, to identify organic obstruction of the main biliary tree. However, it is not sufficiently sensitive to demonstrate functional alterations of the biliary tract.