Meta-analysis of Cholecystectomy in Symptomatic Patients With Positive Hepatobiliary Iminodiacetic Acid Scan Results Without Gallstones

Abstract

Patients without gallstones who have right upper quadrant pain and a positive HIDA scan result are more likely to experience symptom relief following cholecystectomy than those treated medically. There is, however, wide variability in data reporting, particularly with respect to symptom relief and duration of follow-up. Cholecystectomy is indicated in symptomatic patients without gallstones who have a low-ejection fraction HIDA scan.

The Swedish Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks)

“…7 However, the fact that about one-fifth of the patients undergoing surgery are not relieved of their symptoms emphasizes the importance of careful symptom assessment and establishing the right indications for surgery. 8 The postoperative complication rate following gallstone surgery is low but not negligible. Furthermore, patients with iatrogenic common bile duct injuries are found to be almost 3 times as likely to die during the first 5 postoperative years compared with those without bile duct injury.…”

Evidence-Based Medicine for Gallstone Disease Screening: An Experience at Cheng-Hsin General Hospital, Taipei, Taiwan

“…Third, we did estimate the incidence of GSD formation, but rather investigated the incidence of newly screened GSD, focusing only on clinically relevant GSD. Fifthly, we did not evaluate the post cholecystectomy syndrome, which not only can represent either the continuation of symptoms thought to be caused by the gallbladder or the development of new symptoms normally attributed to the gallbladder, but also includes the development of symptoms caused by removal of the gallbladder [20]. Should asymptomatic gallbladder stones be treated with cholecystectomy?…”

Biliary

“…This allows the calculation of an ejection fraction with the normal emptying of the gallbladder being greater than 50 % of the technetium. Abnormal emptying is defi ned as less than 50 % in response to cholecystokinin [ 125 ]. It should be noted that certain medications that are common in elderly patients (i.e., calcium channel blockers and opiates) could also cause impaired gallbladder contraction and emptying and cause an abnormal scintigraphy scan (falsepositive) [ 125 ].…”

“…Symptom relief after cholecystectomy is seen in between 70 and 90 % of patients [ 128 , 129 ]. Patients that have typical biliary symptoms, and abnormal HIDA scan, or occult calculi are most likely to have resolution of symptoms [ 125 ].…”