Cholesterol nucleation time in gallbladder bile of patients with solitary or multiple cholesterol gallstones

Patients with multiple cholesterol gallbladder stones have been
found to be at a higher risk for the recurrence of gallstones after
successful nonsurgical treatment than those with a solitary stone.
Cholesterol gallstone recurrence, like primary gallstone formation,
probably involves a triple defect with supersaturation, abnormally
rapid nucleation of cholesterol in bile and altered gallbladder
motor function. We investigated whether the increased recurrence
rate of patients with multiple stones might be caused by more rapid
nucleation. Therefore the time required for cholesterol monohydrate
crystals to appear in ultracentrifuged bile of patients with
solitary (n = 71) or multiple (n = 42) cholesterol gallstones was
determined. The cholesterol nucleation time was significantly (p
< 0.01) longer in the bile from patients with solitary stones
(< 1 to 16 days, median = 2.0 days) than in the bile from
patients with multiple stones (< 1 to 8 days, median = 1.0
days). Moreover, 15 of 71 (21.1%) patients with solitary
cholesterol stones but only 1 of 42 (2.4%) patients with multiple
cholesterol stones showed a normal (> 4 days) nucleation time.
However, no difference in the cholesterol saturation index was
found between the bile samples from patients with solitary stones
and the bile samples from patients with multiple stones (1.55 ±
0.65 vs. 1.54 ± 0.59, mean ± S.D., respectively). The more rapid
cholesterol nucleation in gallbladder bile may, therefore, be the
major risk factor causing the higher percentage of stone recurrence
in patients with multiple cholesterol stones as compared with
patients with solitary cholesterol stones.