Bile enzyme activities in patients with T-tube drainage following cholecystectomy.

High levels of gamma glutamyl transpeptidase and alkaline phosphatase were found in T-tube bile from patients undergoing cholecystectomy and exploration of the common bile duct for gallbladder and/or ductal stones for up to 9 days after operation. The activities of these enzymes and leucine aminopeptidase were higher in bile than in serum obtained during the period of bile drainage. The patterns of bile activity were different for all 3 enzymes. Gamma glutamyl transpeptidase activity reached a maximum 3 days after operation and then gradually declined, while alkaline phosphatase activity increased progressively for 8 days although values appeared to plateau between Days 7 and 9. There was, however, no significant linear correlation between the mean values of these enzymes. Smaller and more variable changes were observed in the activity of leucine aminopeptidase but on average the levels of this enzyme continued to increase throughout the collection period, and correlated significantly with the values for the other 2 enzymes. Although the high activities of alkaline phosphatase may be due to induction of this enzyme in the liver, the presence of gamma glutamyl transpeptidase and leucine aminopeptidase in the bile is probably a result of continuing hepatic injury. It appears that bile is used as a major route for the elimination of at least these 3 enzymes from damaged tissue in the liver. However, this biliary excretion is probably rather slow and does not appear to be sufficient to prevent the prolonged high levels of serum gamma glutamyl transpeptidase that have been observed following surgical correction of large duct obstruction.