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Surgical Endoscopy

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01-05-2019 | 2018 SAGES Oral

Is hyperkinetic gallbladder an indication for cholecystectomy?

Authors: Shireesh Saurabh, Benjamin Green

Published in: Surgical Endoscopy | Issue 5/2019

Abstract

Background

The (99m) technetium-labelled hepato imino diacetic acid (HIDA) scan is widely used to evaluate patients with biliary colic with a normal trans-abdominal ultrasound scan. Most studies recommend cholecystectomy for patients with biliary dyskinesia, defined by gallbladder ejection fraction (GBEF) of less than 35–40% on HIDA scan. There are no recommendations regarding management of hyperkinetic gallbladder defined by GBEF of greater than 80% on HIDA scan. The aim of our study was to evaluate the outcomes following cholecystectomy on patients with biliary colic associated with hyperkinetic gallbladder.

Methods

We performed a retrospective chart review of all patients with biliary colic associated with hyperkinetic gallbladder that underwent cholecystectomy in our practice from July 2014 to February 2018. Data collection included age, gender, body mass index, preoperative symptoms, comorbidities, additional tests, ejection fraction, surgery, and histopathology of the gallbladder. Symptomatic improvement was assessed during routine 2-week postoperative visit and a follow-up phone interview.

Results

Thirty-two patients had undergone laparoscopic cholecystectomy during the study period for symptomatic hyperkinetic gallbladder. All the patients had abdominal pain related to food intake and 17 (53%) patients had worsening of symptoms with CCK infusion. The average GBEF was 92%. Chronic cholecystitis was seen in 29 (90%) patients on pathology. 23 (74%) patients had complete resolution of biliary symptoms, 5 (16%) had improved symptoms, and 3 (10%) had no change in symptoms.

Conclusion

Patients with biliary colic and hyperkinetic gallbladder respond favorably to laparoscopic cholecystectomy. Our results suggest that patients with biliary colic in the setting of hyperkinetic gallbladder have symptomatic improvement following cholecystectomy.

Lindholm EB, Alberty JB, Hansbourgh F, Upp JR, Lopoo J (2013) Hyperkinetic gallbladder: an indication for cholecystectomy? Am Surg 79(9):882–884PubMed

Law JK, Antoniou A, Kalloo AN, Shin EJ (2014) Tu1951 The hyperkinetic gallbladder-an ignored cause of abdominal pain. Gastroenterology 146(5):S-880CrossRef

Holes-Lewis K, Hakim S, Rehman F, Nabi H, Uhde T (2009) CCK-induced gall bladder hyperkinesia: an indication for cholecystectomy and brain-GI connectivity research. J Nucl Med 50(Suppl. 2):1312

Cook CH, Kisner J, Melvin WS, Olsen J, Pozderac R, Martin LC (1999) Biliary hyperkinesia: a new indication for cholecystectomy Society for Surgery of the Alimentary Tract. Elsevier, New York

Sabbaghian MS, Rich BS, Rothberger GD et al. (2008) Evaluation of surgical outcomes and gallbladder characteristics in patients with biliary dyskinesia. J Gastrointest Surg 12(8):1324–1330. https://doi.org/10.1007/s11605-008-0546-3 CrossRefPubMed

Sorenson M, Fancher S, Lang N, Eidt J, Broadwater J (1993) Abnormal gallbladder nuclear ejection fraction predicts success of cholecystectomy in patients with biliary dyskinesia. Am J Surg 166:672–675CrossRefPubMed

Yost F, Margenthaler J, Presti M, Burton F, Murayama K (1999) Cholecystectomy is an effective treatment for biliary dyskinesia. Am J Surg 178:462–465CrossRefPubMed

Patel N, Lamb J, Hogle N, Fowler D (2004) Therapeutic efficacy of laparoscopic cholecystectomy in the treatment of biliary dyskinesia. Am J Surg 187:209–212CrossRefPubMed

Veenstra BR, Deal RA, Redondo RE, Daly SC, Najman J, Myers JA, Millikan KW, Luu MB (2014) Long-term efficacy of laparoscopic cholecystectomy for the treatment of biliary dyskinesia. Am J Surg 207(3):366–370CrossRefPubMed

10.

Vassiliou MC, Laycock WS (2008) Biliary dyskinesia. Surg Clin N Am 88:1253–1272CrossRefPubMed

11.

McDonnell CO, Bailey I, Stumpf T, Walsh TN, Johnson CD (2002) The effect of cholecystectomy on plasma cholecystokinin. Am J Gastroenterol 97(9):2189–2192CrossRefPubMed

12.

Huckaby L, Timmapuri S, Prasad R (2013) Biliary hyperkinesia: a potentially surgically correctable disorder in adolescents. J Ped Surg Case Reports 1:314–316CrossRef

13.

DuCoin C, Faber R, Ilagan M, Ruderman W, Wier D (2012) Normokinetic biliary dyskinesia: a novel diagnosis. Surg Endosc 26:3088–3093CrossRefPubMed

14.

Morris-Stiff G, Falk G, Kraynak L, Rosenblatt S (2011) The cholecystokin provocation HIDA test: recreation of symptoms is superior to ejection fraction in predicting medium-term outcomes. J Gastrointest Surg 15(2):345–349. https://doi.org/10.1007/s11605-010-1342-4 CrossRefPubMed

15.

Bates T, Ebbs SR, Harrison M, A’Hern RP (1993) Influence of cholecystectomy on symptoms. Br J Surg 78:964–967CrossRef

16.

McMahon AJ, Ross S, Baxter JN et al (1995) Symptomatic outcome 1 year after laparoscopic and minilaparotomy cholecystectomy: a randomized trial. Br J Surg 82:1378–1382CrossRefPubMed

17.

Guj GP, Cheruvu CV, West N, Sivaniah K, Fiennes AG (1998) Is Cholecystectomy effective treatment for symptomatic gallstones? Clinical outcomes after long-term follow-up. Ann R Coll Surg Engl 80(1):25–32

18.

Fenster LF, Lonborg R, Thirlby RC, Traverso LW (1995) What symptoms does cholecystectomy cure? Insights from an outcomes measurement project and review of the literature. Am J Surg 169:533–538CrossRefPubMed

Title: Is hyperkinetic gallbladder an indication for cholecystectomy?
Authors: Shireesh Saurabh
Benjamin Green
Publication date: 01-05-2019
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6435-2

At a glance: The STEP trials

Springer Medicine

Is hyperkinetic gallbladder an indication for cholecystectomy?

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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