Sedimentation of Biliary ‘Sludge’ Effect on Composition of Gallbladder Bile from Patients with Cholesterol, Mixed, or Pigment Stones

Abstract

Background: Ultracentrifugation of bile has been used extensively to remove insoluble material such as ‘sludge’ from bile before further studies of cholesterol nucleation. Although it has been recognized that this procedure may affect the composition of gallbladder bile, it has not been studied systematically in different gallstone populations. Therefore, we investigated the concentration of biliary lipids, protein, mucin, and bilirubin before and after ultracentrifugation. Methods: Gallbladder bile samples were aspirated during laparoscopic surgery from 66 patients (35 with cholesterol, 16 with mixed, and 15 with pigment stones). Results: Whereas the concentrations of bile acids, phospholipids, protein, and bilirubin in gallbladder bile did not change significantly after ultracentrifugation, cholesterol (20.6 ± 1.6 to 14.8 ± 1.2 mmol/1) and mucin concentrations (0.99 ± 0.2 to 0.67 ± 0.1 mg/ml) and the cholesterol saturation index (1.68 ± 0.12 to 1.31 ± 0.10) decreased significantly in gallbladder bile from patients with cholesterol stones. Conclusions: Sedimentation of biliary sludge may profoundly affect the composition of gallbladder bile, which has to be considered in studies of cholesterol saturation and nucleation. The cholesterol concentration difference between native and ultracentrifuged biles reflects the insoluble crystalline fraction of cholesterol and may be useful for quantitation of the mass of cholesterol crystals in gallstone-associated bile samples.

Key Words:

• Cholesterol crystals
• gallbladder bile
• lipid composition
• mucin
• sludge
• total protein
• Ultracentrifugation