• T I Sørensen, D B Toftdahl, L Højgaard, P Cantor, H C Klein, and B Andersen.
• Department of Medical Gastroenterology, Hvidovre Hospital, Copenhagen.
• Dan Med Bull. 1994 Sep 1; 41 (4): 469-72.

Background And AimJejunoileal bypass surgery for obesity increases the risk of gallstone formation, and, contrary to expectations, the incidence is greater in patients with a long as compared to a short ileum left in continuity. Impaired gallbladder motility due to reduced cholecystokinin (CCK) stimulation could be an explanation. The aim of this study was to investigate the CCK levels in such patients.SettingThe randomized trial of bypass surgery named The Danish Obesity Project.Design And MethodsWe compared plasma levels of CCK in obese patients at three, nine or 15 months after jejunoileal bypass surgery with either a 1:3 jejunoileal ratio (n = 14) or a 3:1 ratio (n = 15), and in unoperated obese patients (n = 7). Plasma CCK levels were determined during fasting and during 150 min following ingestion of a liquid test meal.ResultsThere were no significant changes over time following surgery. Basal CCK levels were significantly increased after surgery, and significantly higher in those with a 3:1 than in those with a 1:3 jejunoileal ratio. The postprandial AUC (mean +/- SEM) was 935 +/- 71 pM x min in the 3:1 ratio group and 891 +/- 100 pM x min in the 1:3 ratio group. This difference was not significant, but both bypass groups were significantly higher than the unoperated group (515 +/- 79 pM x min). The integrated increase in plasma CCK above basal level showed a similar pattern, but the difference between the unoperated and the bypass groups was insignificant.ConclusionPostoperative changes in plasma CCK levels neither explain the increased risk of gallstone formation after bypass surgery nor the higher incidence with a long compared to a short ileum left in continuity in the bypass.

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