Joseph C Melvin, MD1, Erica Ibendahl, MD1, Mark Perna, MD2, Arthur L Rawlings, MD, MDiv1. 1University of Missouri, 2Mercy Hospital Berryville, Arkansas
Objective: Classic biliary colic and a cholecystokinin hepatobiliary iminodiacetic acid (CCK-HIDA) scan demonstrating an ejection fraction less than 35% is a well-established indication for cholecystectomy as definitive treatment. However, in patients without stones and symptoms consistent with biliary colic, an ejection fraction >80% is not widely accepted as an indication for cholecystectomy. The objective of our study was to evaluate hyperkinetic biliary dyskinesia (defined as a gallbladder ejection fraction of greater than or equal to 80%) as a predictor of symptom resolution following cholecystectomy.
Methods: All patients undergoing cholecystectomy from 2010 to 2016 at a single institution were reviewed. Patients with an ICD-9 code for cholelithiasis or acute cholecystitis were excluded from the study. A retrospective chart review of the remaining patients was performed. Patients with symptoms consistent with biliary colic (postprandial right upper quadrant pain with or without nausea), a right upper quadrant ultrasound negative for gallstones, and a CCK-HIDA scan with documented ejection fractions greater than or equal to 80 percent were included. A total of 403 patient charts were reviewed, 31 met study criteria and 23 had clearly documented follow up. Improved or resolved preoperative pain, determined from patient’s post-operative clinic visit documentation was the primary endpoint. Surgical pathology was reviewed for evidence of pathologic changes and to confirm the absence of stones.
Results: Of the 23 patients included in the study, 21 patients (91.3%) reported improvement or complete resolution of their preoperative pain. Nineteen (90.5%) of the 21 patients with symptom improvement or resolution had pathologic findings of chronic cholecystitis. Only 2 patients (8.7%) reported no change in preoperative symptoms.
Conclusions: Patients with symptomatic hyperkinetic biliary dyskinesia, as defined by an ejection fraction greater than or equal to 80% on CCK-HIDA may benefit from cholecystectomy. Additionally, 90.5% of patients with improvement or resolution were found to have pathology consistent with chronic cholecystitis providing support of an underlying pathology contributing to symptoms of biliary colic.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79812
Program Number: P112
Presentation Session: Poster (Non CME)
Presentation Type: Poster