Results of Surgical Therapy for Biliary Dyskinesia

Abstract

One hundred eighty-seven patients who presented with symptoms consistent with biliary colic but had no ultrasonic evidence of cholelithiasis were observed in an effort to identify those with a functional gallbladder disorder that might benefit from surgical intervention. All patients underwent quantitative evaluation of gallbladder emptying using cholecystokinin biliary scanning, and ejection fractions less than 35% were considered abnormal. One hundred twenty-nine patients (69%) had abnormal ejection fractions, and 88 (68%) of these subsequently underwent cholecystectomy. Sixty of the surgical specimens revealed pathologic changes. Eighty-four percent of patients successfully contacted for follow-up experienced complete relief, and another 13% had partial relief of preoperative symptoms. Only two patients reported no change in symptom complex. Twenty-nine patients with abnormal ejection fractions elected not to undergo surgery. Fifty-nine percent of these patients continued to experience symptoms of biliary colic at a mean follow-up of 22 months. Of the 44 patients with normal ejection fractions, 35 (80%) reported resolution of symptoms during follow-up of medical treatment. Cholecystokinin biliary scanning can help identify patients with acalculous, functional gallbladder disease who may benefit from cholecystectomy.

Reproducibility of Gallbladder Ejection Fraction Measured by Fatty Meal Cholescintigraphy

“…The main utility of cholescintigraphy is in the confirmation or exclusion of CAC in patients who have a high clinical suspicion of CAC [1][2][3][4][13][14][15]. Gallbladder emptying has several variables, including latent period, GBEF, and patterns of gallbladder emptying [5].…”

“…Measurement of gallbladder ejection fraction (GBEF) by cholescintigraphy (CS) is considered the test of choice for confirming the diagnosis of chronic acalculous cholecystitis (CAC) [1][2][3][4]. Gallbladder emptying has several variables, including latent period, GBEF, and patterns of gallbladder emptying [5].…”

“…However, GBEF is the single most important gallbladder emptying variable in the diagnosis of CAC [5]. Low GBEF is the main abnormal finding upon which the diagnosis of CAC is usually confirmed [1][2][3][4][5]. Cholecystokinin (CCK) is widely used cholagogue stimulant to induce gallbladder contraction in CS [1][2][3][4].…”

“…Low GBEF is the main abnormal finding upon which the diagnosis of CAC is usually confirmed [1][2][3][4][5]. Cholecystokinin (CCK) is widely used cholagogue stimulant to induce gallbladder contraction in CS [1][2][3][4]. Several investigators have found a fatty meal to be a physiologic, easy to handle and cheap alternative to CCK to induce gallbladder contraction in CS [4][5][6][7][8].…”

Hepatobiliary scanning standards fail to identify symptomatic patients with chronic acalculous cholecystitis

“…Normal TUS with persistent symptomatology precipitates a hepatobiliary immunodiacetic acid (HIDA) scan and gallbladder ejection fraction (EF) calculation to assess for biliary dyskinesia. TUS and HIDA scans with EF calculation are effective, non-invasive techniques for identifying patients that will benefit from cholecystectomy (CCY) due to the presence of identifiable gallstones or biliary dyskinesis (Fink-Bennett, et al, 1991;Yap, et al, 1991;Ross, et al, 2011).…”