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

Abstract

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.

Prolonged large bowel transit increases serum deoxycholic acid: a risk factor for octreotide induced gallstones

“…Most previous studies of bile acid composition have been based on either gall bladder bile (obtained at laparotomy,30 by percutaneous gall bladder puncture31 32) or on bile rich duodenal fluid 30. In the present study we used the minimally invasive method of measuring bile acids in fasting serum.…”

GLUCURONIDATION AS A MAJOR METABOLIC CLEARANCE PATHWAY OF 14C-LABELED MURAGLITAZAR IN HUMANS: METABOLIC PROFILES IN SUBJECTS WITH OR WITHOUT BILE COLLECTION

“…The results indicated that biliary excretion was the major elimination route for muraglitazar in humans. Other procedures for bile collection included ultrasound-guided percutaneous fine needle puncture of the gallbladder (Hussaini et al, 1995) and surgical methods such as T-tube drainage (Burnstein et al, 1982;Cheng et al, 1994). All of these methods are complicated and involve surgery, and are, thus, not readily adaptable for use in drug metabolism studies.…”

Human Bile Collection for ADME Studies

“…Invasive techniques for bile collection involve ultrasonically guided percutaneous, sub -, or transhepatic fi neneedle puncture of the gallbladder (Hussaini et al, 1995 ;Wee et al, 1995 ), hepaticojejunostomy (Brookman et al, 1997 ), or T -tube percutaneous biliary drainage in patients after cholecystectomy (Rollins and Klaassen, 1979 ;Lorenz et al, 1984 ;J ü ngst et al, 2001 ;Ghibellini et al, 2006a and2006b ). Availability of such patients is scarce for exploratory drug studies.…”

“…Due to the surgical nature of these procedures, the possibility of infection, bile leakage, hemorrhage, and right upper quadrant pain exist (Nahrwold, 1986 ;Hosking et al, 1992 ;Williams et al, 1994 ;Hussaini et al, 1995 ;Tudyka et al, 1995 ). Also, these patients generally are on multiple coadministered drugs for treatment of their condition or to facilitate the surgical procedures, which may sometimes preclude an accurate assessment of the metabolism of the investigational drug.…”