BACKGROUND AND AIMS Bile is the only significant pathway for cholesterol elimination. Cholecystectomy (CS) increases fecal bile acid loss, and endoscopic biliary sphincterotomy (ES) is thought to have a similar effect. We speculated that a combined effect of ES + CS would further enhance fecal bile acid loss, potentially causing lipid profile changes in these patients. METHODS Fecal bile acids and sterols were determined using gas chromatography in cohorts of post-CS + ES, post-CS and in healthy controls. The effect of ES + CS on blood lipid profile was assessed retrospectively in a single-center cohort of post-CS + ES patients, using a computerized database. Parameters of interest included demographics, medical history, and lipid profiles. RESULTS Fecal primary bile acid concentrations were increased after CS + ES compared to CS and controls (cholic acid [CA] 1.4 ng/mg vs. 0.26 ng/mg, p = 0.02 vs. 0.23 ng/mg, p = 0.004, chenodeoxycholic acid [CDCA] 1.92 ng/mg vs. 0.39 ng/mg, p = 0.02 vs. 0.23 ng/mg, p = 0.01, respectively). Fecal cholesterol excretion was similar in all three groups. Baseline serum lipid profile and subsequent changes following CS + ES were correlated. In patients with baseline hypercholesterolemia (total cholesterol (TC) > 200 mg/dl), TC levels decreased by 28.5 mg/dl, and LDL levels decreased by 21.5 mg/dl. The effect was more pronounced in those with TC > 200 mg/dl, despite of statin intake. In patients with hypertriglyceridemia [triglycerides (TG) > 200 mg/dl], TG decreased by 67.8 mg/dl following ES + CS. Among patients without dyslipidemia or dyslipidemia with adequate response to statins, the effect of ES + CS on lipid profile was minor. CONCLUSIONS Fecal bile acid loss increases following CS + ES. The effect on blood lipid profile depends on baseline TC and TG levels. Lipid profile is improved in dyslipidemic patients, while the impact of CS + ES is minimal on the normolipemic population.

中文翻译：

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胆囊切除术和胆道括约肌切开术增加了血脂异常的粪便胆汁损失并改善了脂质谱。

背景与目的胆汁是消除胆固醇的唯一重要途径。胆囊切除术（CS）会增加粪便胆汁酸的流失，而内镜下胆囊括约肌切开术（ES）也具有类似的作用。我们推测，ES + CS的联合作用将进一步增加粪便胆汁酸的流失，从而可能导致这些患者的血脂变化。方法采用气相色谱法测定CS + ES后，CS后和健康对照人群的粪便胆汁酸和固醇。使用计算机化数据库回顾性研究了CS + ES后患者的单中心队列中ES + CS对血脂状况的影响。感兴趣的参数包括人口统计学，病史和脂质分布。结果与CS和对照组相比，CS + ES后粪便中的初级胆汁酸浓度升高（胆酸[CA] 1.4 ng / mg对0.26 ng / mg，p = 0.02对0.23 ng / mg，p = 0.004，鹅去氧胆酸[CDCA]分别为1.92 ng / mg与0.39 ng / mg，p = 0.02与0.23 ng / mg，p = 0.01）。所有三组的粪便胆固醇排泄均相似。基线血清脂质谱和CS + ES后的后续变化相关。在基线高胆固醇血症（总胆固醇（TC）> 200 mg / dl）的患者中，TC水平下降28.5 mg / dl，LDL水平下降21.5 mg / dl。尽管他汀类药物的摄入量，但在TC> 200 mg / dl的患者中，这种作用更为明显。高甘油三酸酯血症[甘油三酸酯（TG）> 200 mg / dl]的患者，ES + CS后TG降低67.8 mg / dl。在没有血脂异常或对他汀类药物有充分反应的血脂异常的患者中，ES + CS对血脂的影响较小。结论CS + ES后，粪便胆汁酸损失增加。对血脂水平的影响取决于基线TC和TG水平。血脂异常患者的血脂状况得到改善，而CS + ES对正常人群的影响很小。