Emmanuel A Agaba, MD, Alyse McNeill, PAC, MSPAS. Marietta Memorial Hopsital, Marietta OH
Increasingly, more patients with gallbladder and biliary dyskinesia are being recognized in United States. Although improved technology may be responsible for this increase, it is questionable whether this alone maybe responsible for the surge in the diagnosis.
Biliary dyskinesia is a diagnosis of exclusion, and the symptoms associated with functional gallbladder disorder may mimic symptoms seen in patients with various disorders, including peptic ulcer disease, ischemic heart disease, and functional dyspepsia.
This study aims at reviewing one surgeon’s experience with this complex disease entity.
Methods: Between April 2014 and June 2016, all patients with right upper quadrant pain that occurs for at least 30 minutes at variable intervals in the absence of gallstones or other structural abnormalities and sufficient to warrant emergent room visit. Importantly, the patient’s pain is not significantly relieved by bowel movements, acid suppression or postural changes. All patients had normal liver enzymes, conjugated bilirubin and lipase/amylase.
To qualify CCK-stimulated cholescintigraphy is used to estimate the gallbladder ejection fraction (GBEF).
In preparation, following an overnight fast, 99mTc-diisopropyl-iminodiacetic acid (DISIDA) or 99mTc-hepatic iminodiacetic acid (HIDA) is given as an intravenous bolus. After 45 to 90 minutes, baseline radioactivity from the region of the gallbladder is measured. When the radioactivity is maximal from the gallbladder and is minimal from the liver, a slow infusion of CCK is started to stimulate gallbladder contraction, which leads to expulsion of the radio labeled tracer (Sincalide 0.02mcg/kg given over 30 to 60 minutes).
A diagnosis of biliary dyskinesia is made if the GBEF was less than 40%
All these patients were offered laparoscopic cholecystectomy. Dataset was collected prospectively.
Results: Ninety-seven patients met the diagnostic criteria. All patients had negative transabdominal ultrasonographic and computed axial tomographic scans as well as upper gastrointestinal endoscopy. All patients were offered laparoscopic cholecystectomy and were followed for 6 months. During postoperative visits, the patients were asked specifically for resolution of their symptoms. Eighty-two patients have complete disease resolution, 10 patients continued to have persistent pain while 4 patients had persistent diarrhea. One patient was lost to follow up after 3 months.
Conclusions: Although more patients are presenting with biliary dyskinesia, some authorities have questioned the validity of such a disease entity; our study has shown that biliary dyskinesia is a true disease that is remediable by surgical intervention.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78973
Program Number: P095
Presentation Session: Poster (Non CME)
Presentation Type: Poster