Gallstone composition in relation to buoyancy at oral cholecystography

Although it is recognized that some gallstones float at oral cholecystography, the reasons for this are not known. To determine how stone type and composition are related to stone buoyancy, the authors analyzed gallstones from 90 patients in the National Cooperative Gallstone Study. Seventeen patients had floating and 73 had nonfloating radiolucent stones at oral cholecystography. Stone analysis showed that all 17 floating stones were cholesterol stones; 64 of the nonfloating stones were cholesterol stones, while nine were pigment stones. The cholesterol contents of floating and nonfloating cholesterol stones were similar, 90.4% +/- 1.7 and 87.0% +/- 1.2 of stone weight, respectively. The calcium salt content of the nonfloating cholesterol stones was 3.2% +/- 0.6, while that of the floating cholesterol stones was only 1.1% +/- 0.4 (P = .02). The results indicate that floating gallstones are cholesterol stones with a significantly lower calcium salt content than that of nonfloating cholesterol stones.