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Cholecystectomy and Biliary Sphincterotomy Increase Fecal Bile Loss and Improve Lipid Profile in Dyslipidemia

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Abstract

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.

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Abbreviations

CA:

Cholic acid

CDCA:

Chenodeoxycholic acid

CS:

Cholecystectomy

DCA:

Deoxycholic acid

ES:

Endoscopic biliary sphincterotomy

HDL:

High-density cholesterol

LCA:

Lithocholic acid

TBA:

Total bile acids

TC:

Total blood cholesterol

TG:

Triglycerides

UDCA:

Ursodeoxycholic acid

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Acknowledgments

We thank Professor Uri Gophna for his help with study concept and preparation.

Funding

This study was supported in part by the Josefina Maus and Gabriela Cesarman Chair for Research in Liver Diseases, Sackler Faculty of Medicine, Tel Aviv University.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Meir Medical Center, Tchernichovsky St.59, 4428164, Kfar Saba, Israel

    Ilia Sergeev, Nirit Keren, Timna Naftali & Fred M. Konikoff

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Nirit Keren, Timna Naftali & Fred M. Konikoff

Authors
  1. Ilia Sergeev
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  2. Nirit Keren
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  3. Timna Naftali
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  4. Fred M. Konikoff
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Correspondence to Ilia Sergeev.

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Sergeev, I., Keren, N., Naftali, T. et al. Cholecystectomy and Biliary Sphincterotomy Increase Fecal Bile Loss and Improve Lipid Profile in Dyslipidemia. Dig Dis Sci 65, 1223–1230 (2020). https://doi.org/10.1007/s10620-019-05823-z

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