Alteration of Gallbladder Bile Composition after Curative Gastrectomy for Cancer

Yuzuru Sugiyama, Hiroshi Moriya*, Ryukichi Hada*, Hiroyasu Kobori*, Dai Seito*, Yasunori Mikami*, Hidetoshi Suzuki*, Mitsuru Konn*

Allied Medical Science, Hirosaki University
*Second Department of Surgery, Hirosaki University School of Medicine

Lithogenic bile production and bile infection have been among the main theories of gallstone formation after curative gastrectomy for cancer. We collected gallbladder (GB) bile at the time of cholecystectomy from 7 patients gastrectomized for cancer who had developed GB stone. The bile was analyzed for its composition and was cultured for bacteriology. GB bile collected from 15 gastric cancer patients during gastrectomy was used as the control. The GB stones from the 7 patients were classified as 5 bilirubinate, 1 black and 1 mixed stones. Bile infection was seen in 4 of the 5 patients with bilirubinate stone but in none of the control subjects. Chenodeoxycholic acid levels for the patients with GB stone (except those with percutaneous transhepatic gallbladder drainage) were significantly lower than those for the control subjects (p<0.039). Total bile acid, cholesterol, phospholipid, bilirubin and total calcium contents were also low for the patients with GB stone compared with those for the control subjects. Free bile acids were detected exclusively in 3 of the 5 patients with bilirubinate stone, which indicated the involvement of bile infection in the formation of bilirubinate stone after curative gastrectomy for cancer. An explanation of the development of black stone after gastrectomy will require further investigation.

Key words
gallstone disease after gastrectomy for cancer, gallbladder bile composition, infection of the bile, bile acid

Reprint requests
Yuzuru Sugiyama Hirosaki University Allied Medical Science
66-1 Hon-cho, Hirosaki, 036 JAPAN

Accepted
February 9, 1994

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