Author/Editor		Vračko, Jožef; Wiechel, Karl-Ludvig
Title		Trypsin level in gallbladder bile and ductitis and width of the cystic duct
Type		članek
Source		Hepatogastroenterology
Vol. and No.		Letnik 47, št. 31
Publication year		2000
Volume		str. 115-20
Language		eng
Abstract		Background/Aims: The change from laparotomy to laparoscopy for cholecystectomy has raised the question of how to manage concomitant bile duct stones. The present-day interest - and controversy - has focused on a transcystic approach reported to be feasible in 66-96% of cases, but without explaining the necessary prerequisite: the widening of the cystic duct. The cystic duct, wide mainly in patients with bile duct stones, has been reported to be highly variable: from strictured to very wide. The present study aims at comparing the trypsin level in the gallbladder bile and the cystic duct morphology and width in patients with and without bile duct stones. Methodology: A prospective series of 63 gallstone patients, 30 with and 33 without bile duct stones (controls), underwent cholecystectomy and bile duct clearance. The study includes the trypsin level in the gallbladder bile, the width and morphology of the cystic duct, and the size of the gallstones. Results: The patients with bile duct stones had, in contrast to the controls, higher trypsin levels in the gallbladder bile (P<0.001) and wider cystic ducts (P<0.001) with more pronounced signs of chronic ductitis. Conclusions: The obtained results strongly suggest that the increased trypsin level, a sign of reflux of pancreatic juice, caused changes in the cystic duct that facilitate gallstone migration, which also ought to render a transcystic stone extraction feasible.
Descriptors		CYSTIC DUCT CHOLELITHIASIS CHOLECYSTECTOMY, LAPAROSCOPIC BILE TRYPSIN CHOLANGIOGRAPHY PROSPECTIVE STUDIES GALLBLADDER