Diagnostic fine-needle puncture of the gallbladder.

Herbetko, J.; Fache, J S

doi:10.1148/radiology.180.2.2068336

Cited by 2 publications

(6 citation statements)

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“…A fourth patient from this series suffered bleeding from the liver. Thus, the findings in the present study and those in the study by Herbetko et al [9] contrast with the experience of Swobodnik et al [8]. These authors described 118 patients who underwent ultrasound-guided PFNP-GB for diagnostic purposes.…”

Section: Discussioncontrasting

confidence: 97%

“…Gallbladder puncture has also been used therapeutically in patients with suspected gallbladder empyema [19] or in those with acute cholecystitis who are unfit for cholecystectomy [20]. However, it is only over the last 2 years that the technique has been described for diagnostic purposes in uncomplicated gallstone disease [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study by Herbetko et al [9], 44 patients with GBS underwent PFNP-GB before cholecystectomy. Three developed signs of peritonitis and, at surgery, this was found to be due to leakage of bile.…”

Section: Discussionmentioning

confidence: 99%

“…Only three required post-procedural analgesia and the ultrasonographic appearances after gallbladder puncture were normal. Herbetko et al [9] used a transperitoneal, sub-hepatic approach, as opposed to the transhepatic approach adopted by Swobodnik and ourselves, to puncture the gallbladder. This may explain the three episodes of biliary peritonitis in Herbetko's series.…”

Section: Discussionmentioning

confidence: 99%

“…such variables as the cholesterol microcrystal nucleation time [6,7]. • For all these reasons, there is no substitute for fresh samples of human gallbladder bile, and these may be obtained by ultrasound-guided percutaneous fine needle puncture of the gallbladder (PFNP-GB) [8,9]. We used this technique to obtain fresh samples of gallbladder bile for studies of bile acid and bile lipid composition, the partitioning of biliary cholesterol between micelles and vesicles and the cholesterol microcrystal nucleation time.…”

mentioning

confidence: 99%

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Ultrasound-guided percutaneous fine needle puncture of the gallbladder for studies of bile composition

Hussaini¹,

Kennedy²,

Pereira³

et al. 1995

The British Journal of Radiology

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Ultrasound-guided percutaneous fine needle puncture of the gallbladder (PFNP-GB) is invaluable for diagnostic and research purposes, but there are few reports about its safety. We therefore describe the efficacy and side-effects of 43 consecutive gallbladder punctures in 39 patients. PFNP-GB was successful in 40/43 (93%), but failed in three. Bile was completely aspirated in 28 of the 40 (70%) successful procedures. After 36 of the 43 punctures (84%), the patients remained asymptomatic, although on seven occasions (16%) the patients complained of right upper quadrant pain 0.5-12 h after the procedure. In six of these, the pain resolved in 2-24 h, although one developed a leucocytosis (22 x 10(9) 1(-1)). The seventh patient developed pyrexia and signs of generalized peritonism, which settled with conservative therapy. Ultrasonographic abnormalities of the gallbladder wall were seen in five of the seven symptomatic patients, consisting of: (i) an increase in the thickness of the gallbladder wall (n = 5) from less than 2 mm to 4-14 mm; (ii) peri-cholecystic collections (n = 2) measuring 5 and 11 mm in diameter; (iii) an intraluminal mucosal flap (n = 1); (iv) an intraluminal echogenic layer (n = 1); and (v) a 12 cm intraabdominal haematoma in the patient with generalized peritonism. Predictors of pain were: (i) the number of needle "passes" (3.7 +/- 0.8, range 2-8, in patients with pain vs 2.0 +/- 0.2, range 1-6, in pain-free patients, p < 0.02); (ii) the absence of gallbladder stones (p < 0.03); and (iii) incomplete aspiration of bile from the gallbladder (p < 0.02). PFNP-GB is an effective way of sampling fresh gallbladder bile, although there is a 16% risk of inducing pain and/or ultrasonographic changes in the gallbladder.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Ultrasound-guided percutaneous fine needle puncture of the gallbladder for studies of bile composition

Hussaini¹,

Kennedy²,

Pereira³

et al. 1995

The British Journal of Radiology

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Review: pathogenesis of gallstones

Dowling

2000

Aliment Pharmacol Ther

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Summary The aim of this article is to review selected aspects of the pathogenesis of cholesterol‐rich, gall‐bladder stones (GBS) – with emphasis on recent developments in biliary cholesterol saturation, cholesterol microcrystal nucleation, statis within the gall‐bladder and, particularly, on the roles of intestinal transit and altered deoxycholic acid (DCA) metabolism, in GBS development. In biliary cholesterol secretion, transport and satura‐ tion, recent developments include evidence in humans and animals, that bile lipid secretion is under genetic control. Thus in mice the md‐2 gene, and in humans the MDR‐3 gene, encodes for a canalicular protein that acts as a ‘flippase' transporting phospholipids from the inner to the outer hemi‐leaflet of the canalicular membrane. In the absence of this gene, there is virtually no phospho‐ lipid or cholesterol secretion into bile. Furthermore, when inbred strains of mice that have ‘lith genes' are fed a lithogenic diet, they become susceptible to high rates of GBS formation. The precipitation/nucleation of cholesterol micro‐ crystals from supersaturated bile remains a critical step in gallstone formation. methods of studying this phenomenon have now been refined from the original ‘nucleation time' to measurement of cholesterol appearance/detection times, and crystal growth assays. Furthermore, the results of recent studies indicate that, in addition to classical Rhomboid‐shape monohydrate crystals, cholesterol can also crystallize, transiently, as needle‐, spiral‐ and tubule‐shaped crystals of anhydrous cholesterol. A lengthy list of promoters, and a shorter list of inhibitors, has now been defined. There are many situations where GB stasis in humans is associated with an increased risk of gallstone forma‐ tion – including iatrogenic stone formation in acro‐ megalic patients treated chronically with octreotide (OT). As well as GB stasis, however, OT‐treated patients all have ‘bad' bile which is supersaturated with cholesterol, has excess cholesterol in vesicles, rapid microcrystal mulceation times and a two‐fold increase in the percentage DCA in bile. This increase in the proportion of DCA seems to be due to OT‐induced prolongation of large bowel transit time (LBTT). Thus LBTT is linearly related to (i) the percentage of DCA in serum; (ii) the DCA pool size; and (III) the DCA input or ‘synthesis' rate. Furthermore, the intestinal prokinetic, cisapride, counters the adverse effects of OT on intestinal transit, and ‘normalizes' the percentage of DCA in serum/bile. Patients with spontaneous gallstone disease also have prolonged LBTTs, more colonic Gram‐positive an‐ aerobes, increased bile acid metabolizing enzymes and higher intracolonic pH values, than stone‐free controls. Together, these changes lead to increased DCA formation, solubilization and absorption. Thus, in addition to the ‘lithogenic liver' and ‘guilty gall‐bladder' one must now add the ‘indolent intestine' to the list of culprits in cholesterol gallstone formation.

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Diagnostic fine-needle puncture of the gallbladder.

Cited by 2 publications

References 0 publications

Ultrasound-guided percutaneous fine needle puncture of the gallbladder for studies of bile composition

Ultrasound-guided percutaneous fine needle puncture of the gallbladder for studies of bile composition

Review: pathogenesis of gallstones

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