Detection of occult gallbladder disease by duodenal drainage collected endoscopically. A clinical and pathologic correlation.

The bile of 100 patients with abdominal pain (suspected of having gallbladder disease) was collected from the duodenum at the time of esophagogastroduodenoscopy and examined for cholesterol and calcium bilirubinate crystals. Sixty of these patients had both negative oral cholecystograms and negative gallbladder sonograms, as well as no other objective evidence of gallbladder pathology. These patients are the subject of this report. Thirty-eight per cent of the 60 patients demonstrated crystals in bile collected at the time of endoscopy. None of the patients treated medically showed any improvement. Eight of the patients (35%) underwent cholecystectomy with 75 per cent of the gallbladders showing histologic pathology, and the remainder showing no pathology. However, all patients undergoing surgery who responded to a questionnaire improved whether or not pathology was found in the gallbladder. In contradistinction, of the patients undergoing surgery in whom no crystals were seen in the bile collected from the duodenum, pathology was found in only one third of the gallbladders and these patients' symptoms improved with surgery. Two thirds of the remaining patients had no pathologic changes in their gallbladder and only 50 per cent of these patients showed any improvement following surgery. However, patients who did not have crystals in their bile and were treated without surgery had a 58 per cent improvement rate with medical treatment alone. Duodenal drainage collected at the time of endoscopy and examination of the bile for cholesterol and bilirubinate crystals is a valuable adjunct in predicting which patients will respond favorably to cholecystectomy when there is no radiographic evidence of gallbladder disease.