RESUMEN
BACKGROUND AND OBJECTIVES: It was proposed that occult pancreaticobiliary reflux (OPBR) was associated with precancerous mucosal changes in the gallbladder, hence the importance of this disorder. There are no published reports investigating the incidence of OPBR in patients operated on for the entire spectrum of benign gallbladder diseases and gallbladder cancer. Our aim was to determine the incidence of OPBR and measure the levels of active pancreatic enzymes (amylase and lipase) in gallbladder bile of patients undergoing cholecystectomy for benign and malignant gallbladder diseases. METHODS: One hundred eight patients with normal pancreaticobiliary junction evidenced by operative cholangiography were included in the study. RESULTS: According to gallbladder bile amylase and lipase levels, 84.2% and 89% patients respectively had OPBR. OPBR was present in all gallbladder cancer patients; in these patients the biliary levels of amylase and lipase were significantly higher than the levels found in patients with benign gallbladder pathology (P < 0.0001). CONCLUSIONS: OPBR could lead to inflammatory changes of the biliary epithelium and progress towards the development of precancerous mucosal changes and gallbladder cancer. The reason why such high levels of pancreatic enzymes are regurgitated into the biliary tree of patients with gallbladder cancer should be clarified.
Asunto(s)
Amilasas/análisis , Enfermedades de los Conductos Biliares/etiología , Reflujo Biliar/etiología , Bilis/enzimología , Enfermedades de la Vesícula Biliar/complicaciones , Neoplasias de la Vesícula Biliar/complicaciones , Lipasa/análisis , Enfermedades Pancreáticas/etiología , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de los Conductos Biliares/enzimología , Reflujo Biliar/enzimología , Colecistitis/complicaciones , Colecistitis/enzimología , Femenino , Enfermedades de la Vesícula Biliar/enzimología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/enzimologíaAsunto(s)
Bilis/química , Colecistitis Aguda/fisiopatología , Enfermedades del Conducto Colédoco/fisiopatología , Esfínter de la Ampolla Hepatopancreática , Tripsina/análisis , Colecistitis Aguda/complicaciones , Enfermedades del Conducto Colédoco/complicaciones , Vesícula Biliar/fisiopatología , Humanos , Esfinterotomía EndoscópicaRESUMEN
Clinical and surgical observations confirm that acute cholecystitis (ACh) and acute biliary pancreatitis can coexist and that differentiation may be difficult even at surgery. Synchronous appearance of ACh and acute biliary pancreatitis suggests a similar etiology. Endoscopic sphincterotomy, with relief of the common channel outlet obstruction, has become the established therapeutical modality that improves the outcome in acute biliary pancreatitis. Patients suffering from ACh could be treated in a similar manner to prevent reflux of pancreatic juice into the common bile duct and the gallbladder with the intention to improve the clinical course. The present study investigated the presence and amount of pancreatic trypsin in the gallbladder bile in 73 patients operated on for gallstone disease with ACh and in controls. The average gallbladder bile trypsin level in the "edematous cholecystitis" group ranged between 0.525 and 4500 ng/mL, significantly exceeding that of controls, 0.5-53 ng/mL (P < 0.0001). The average gallbladder bile trypsin level in the "gangrenous cholecystitis" group, 0.1-71.5 ng/mL, was within the range of controls (n.s.), most likely to be explained as a consequence of consumption of trypsin due to the fulminant development of the disease. Further controlled studies are mandatory before it would be acceptable to recommend endoscopic sphincterotomy as a valuable choice in the initial/early management of patients suffering from ACh. Such a study is underway to assess the possible role of obstruction at, or other disorders of, the sphincter of Oddi with consequent pancreatic juice reflux into the gallbladder as a possible initial cause of ACh.