Baongoc Nasri, MD, PhD1, Brian Gilchrist, MD2, Timothy Glass, MD1, Jonathan Saxe, MD1. 1St. Vincent Hospital, 2New York University Winthrop Hospital
Background: The main indications for laparoscopic cholecystectomy are stone related diseases in adults. With a normal abdominal ultrasound (US), a hepatobiliary iminodiacetic acid (HIDA) scan with ejection fraction (EF) is recommended to evaluate gallbladder function. Biliary dyskinesia or low gallbladder ejection fraction (GBEF<35%) is a recognized indication for cholecystectomy in children. However, not only do patients have low ejection fractions, but a significant number have hyperactive ejection fractions with GBEF >80%. There are multiple articles showing long term resolution of symptoms in children with hyperkinetic ejection fractions on HIDA scan. The purpose of this study is to evaluate whether hyperkinetic gallbladder (GBEF>80%) could be an indication for cholecystectomy in adult population.
Methods: Data were consecutively collected from all patient underwent laparoscopic cholecystectomies between June 2012 and June 2017 at a single institution. Patients less than 18 year of age or missing data were excluded. Patients with a negative US (no stone, no sludge, no gallbladder wall thickening) and GBEF greater than 80% were included in this study.
Results: Over a five-year period from June 2012 until June 2017, 36 patients were identified to fit the inclusion criteria for this study. There were 33 women and 3 men with a mean age of 52±13.87 years, all had an GBEF greater than 80% with a mean of 89±4.45%. Mean BMI was 30 kg/m2 (range, 14- 48.8) 3 patients (8.3%) had daily bouts of nausea or emesis. All patients had biliary colicky pain for more than one month. Patients had undergone several additional studies: endoscopy (23), colonoscopy (6), gastric emptying study (6), CT scan (9). Pathology reports were reviewed: only 3 (8.3%) patients had a normal gallbladder, 27 (75%) had chronic cholecystitis, and 6 (16.7%) had chronic cholecystitis with cholesterolosis. All patients were seen in follow up 4 to 6 weeks postoperatively. 33 had complete resolution of symptoms, two had partial resolution and one had no change. There was a complete resolution rate of 91.7% and an improvement rate of 97.2%.
Conclusions: Long term resolution of symptoms in children with hyperkinetic ejection fractions on HIDA scan have been documented. In this series of adult patients who presented with biliary symptoms, negative ultrasound and elevated GBEF on HIDA scan (EF>80%), laparoscopic cholecystectomy led to significant rate of symptomatic relief. This disease process requires further analysis, but this could represent a new indication for laparoscopic cholecystectomy in the adult population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92598
Program Number: P220
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster