[Analysis of bile and gallstones in 116 patients with symptomatic cholelithiasis]

Gallbladder bile and stones were obtained at 116 cholecystectomies for symptomatic gallstone disease. All 33 patients younger than 50 years had cholesterol stones, whereas 40% of the older patients had pigment stones. We compared the reliability for the differentiation between these two stone types of three different bile tests: cholesterol saturation index, examination of fresh gallbladder bile for presence of cholesterol monohydrate crystals, and nucleation time of ultrafiltered gallbladder bile. Only examination of fresh gall bladder bile for presence of cholesterol crystals was specific and reasonably sensitive for cholesterol gallstone disease regardless of bile concentration. Duodenal bile obtained from 16 patients (10 cholesterol, 6 pigment) before cholecystectomy showed cholesterol crystals in 7 of the cholesterol but in none of the pigment stone patients. This examination may be useful for patient selection for non-operative therapy in gallstone disease, which can only be considered in case of cholesterol gallstones.