In vitro investigation of the origin of echoes within biliary sludge

Filly, Roy A.; Allen, Bruce G.; Minton, Mary; Bernhoft, Robin A.; Way, Lawrence W.

doi:10.1002/jcu.1870080302

Cited by 84 publications

(19 citation statements)

References 23 publications

(22 reference statements)

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“…On ultrasonography, sludge appears as low-level echoes [10]. On microscopy, it has been defined as a mixture of particulate matter that occurs when various solutes in bile precipitate [11][12][13].…”

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confidence: 99%

The clinical significance of bile duct sludge: is it different from bile duct stones?

2007

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confidence: 99%

The clinical significance of bile duct sludge: is it different from bile duct stones?

2007

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“…Its presence can be suggested by transabdominal ultrasonography as hyperechoic non-shadowing mobile images, the so-called “biliary sludge”,2 but its definitive demonstration is based on finding biliary crystals on microscopic examination of duodenal bile 3…”

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confidence: 99%

Biliary lipid composition in cholesterol microlithiasis

Fracchia¹,

Pellegrino²,

Secreto³

et al. 2001

Gut

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Background-Little information is available on the pathogenesis of cholesterol microlithiasis, and it is not clear if biliary lipid composition in these patients is similar to changes seen in cholesterol gall stone patients. 51 (1.40-1.63)). This was due to a significant decrease in per cent phospholipid (10.0% (7.1-12.8)) compared with controls (21.4% (18.1-24.6)) and gall stone patients (24.9% (20.5-29.3)). Per cent cholesterol was similar in patients with microlithiasis and controls (5.3% (4.5-6.1) and 5.6 % (4.3-6.8), respectively) but was significantly increased in gall stone patients (10.9% (9.3-12.4)). Bile acid composition in patients with microlithiasis was similar to controls whereas in gall stone patients deoxycholic acid was significantly increased: 27.3% (24.8-29.7) v 19.0% (15.7-22.2) in controls and 20.6% (14.9-26.2) in patients with microlithiasis. Conclusion-Patients with cholesterol microlithiasis have biliary cholesterol supersaturation, similarly to cholesterol gall stone patients. Whereas in the latter this is due to increased per cent cholesterol, in patients with microlithiasis this is caused by phospholipid deficiency, with normal per cent cholesterol and normal biliary bile acid composition. (Gut 2001;48:702-706) Aims-To

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“…Presence of microcalculi was also shown in 8.3% of patients with bile sludge who underwent surgery 27 . It can be concluded that presence of bile sludge should be considered abnormal, since there may be precipitates of calcium bilirubinate or cholesterol (microcalculi) 28 . In this series, three cases presented with appearance of bile sludge on EUS, and surgical findings revealed the presence of microcalculi.…”

Section: Discussionmentioning

confidence: 99%

“…If the calculi range between 3 and 5 mm in diameter, the rate is 40% 5 and, if the radiolucency criterion is used, the rate falls to 10%. For this reason, calculi less than or equal to 3 mm in diameter are a diagnostic challenge, particularly because of confusion with bile sludge [26][27][28] .…”

Section: Discussionmentioning

confidence: 99%

Microlithiasis of the gallbladder: role of endoscopic ultrasonography in patients with idiopathic acute pancreatitis

Ardengh¹,

Malheiros²,

Rahal³

et al. 2010

Rev. Assoc. Med. Bras.

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SummaryObjectives. Causes may be found in most cases of acute pancreatitis, however no etiology is found by clinical, biological and imaging investigations in 30% of these cases. Our objective was to evaluate results from endoscopic ultrasonography (EUS) for diagnosis of gallbladder microlithiasis in patients with unexplained (idiopathic) acute pancreatitis. MethOds. Thirty-six consecutive non-alcoholic patients with diagnoses of acute pancreatitis were studied over a five-year period. None of them showed signs of gallstones on transabdominal ultrasound or tomography. We performed EUS within one week of diagnosing acute pancreatitis. Diagnosis of gallbladder microlithiasis on EUS was based upon findings of hyperechoic signals of 0.5-3.0 mm, with or without acoustic shadowing. All patients (36 cases) underwent cholecystectomy, in accordance with indication from the attending physician or based upon EUS diagnosis. Results. Twenty-seven patients (75%) had microlithiasis confirmed by histology and nine did not (25%). EUS findings were positive in twenty-five. Two patients had acute cholecystitis diagnosed at EUS that was confirmed by surgical and histological findings. In two patients, EUS showed cholesterolosis and pathological analysis disclosed stones not detected by EUS. EUS diagnosed microlithiasis in four cases not confirmed by surgical treatment. In our study, sensitivity, specificity and positive and negative predictive values to identify gallbladder microlithiasis (with 95% confidence interval) were 92.6% (74.2-98.7%), 55.6% (22.7-84.7%), 86.2% (67.4-95.5%) and 71.4% (30.3-94.9%), respectively. Overall EUS accuracy was 83.2%. cOnclusiOns. EUS is a very reliable procedure to diagnose gallbladder microlithiasis and should be used for the management of patients with unexplained acute pancreatitis. This procedure should be part of advanced endoscopic evaluation.

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In vitro investigation of the origin of echoes within biliary sludge

Cited by 84 publications

References 23 publications

The clinical significance of bile duct sludge: is it different from bile duct stones?

The clinical significance of bile duct sludge: is it different from bile duct stones?

Biliary lipid composition in cholesterol microlithiasis

Microlithiasis of the gallbladder: role of endoscopic ultrasonography in patients with idiopathic acute pancreatitis

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