ULTRASOUND-GUIDED PERCUTANEOUS FINE-NEEDLE PUNCTURE OF THE GALLBLADDER FOR STUDIES OF BILE COMPOSITION

Ultrasound-guided percutaneous fine needle puncture of the gallbladder (PFNP-GB) is invaluable for diagnostic and research purposes, but there are few reports about its safety. We therefore describe the efficacy and side-effects of 43 consecutive gallbladder punctures in 39 patients. PFNP-GB was successful in 40/43 (93%), but failed in three. Bile was completely aspirated in 28 of the 40 (70%) successful procedures. After 36 of the 43 punctures (84%), the patients remained asymptomatic, although on seven occasions(16%) the patients complained of right upper quadrant pain 0.5-12 h after the procedure. In six of these, the pain resolved in 2-24 h, although one developed a leucocytosis (22 x 10(9) l(-1)). The seventh patient developed pyrexia and signs of generalized peritonism, which settled with conservative therapy. Ultrasonographic abnormalities of the gallbladder wall were seen in five of the seven symptomatic patients, consisting of: (i) an increase in the thickness of the gallbladder wall (n=5) from less than 2 mm to 4-14 mm; (ii) peri-cholecystic collections (n=2) measuring 5 and 11 mm in diameter; (iii) an intraluminal mucosal flap (n=1); (iv) an intraluminal echogenic layer (n=1); and (v) a 12 cm intraabdominal haematoma in the patient with generalized peritonism. Predictors of pain were: (i) the number of needle ''passes'' (3.7+/-0.8, range 2-8, in patients with pain vs 2.0+/-0.2, range 1-6, in pain-free patients, p<0.02); (ii) the absence of gallbladder stones (p<0.03); and (iii) incomplete aspiration of bile from the gallbladder (p<0.02). PFNP-GB is an effective way of sampling fresh gallbladder bile, although there is a 16% risk of inducing pain and/or ultrasonographic changes in the gallbladder.