Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 11/2012

01-11-2012

Normokinetic biliary dyskinesia: a novel diagnosis

Authors: Christopher DuCoin, Robert Faber, Marlon Ilagan, William Ruderman, Daryl Wier

Published in: Surgical Endoscopy | Issue 11/2012

Login to get access

Abstract

Background

Biliary dyskinesia diagnosed with CCK-HIDA scan and ejection fraction less than 35 % has been successfully treated by laparoscopic cholecystectomy. However, a population of patients with symptomatic biliary pain and a normal CCK-HIDA scan never receive a diagnosis, and thus no definitive treatment. Some of these patients report a reproducible pain during their CCK-HIDA scan. It is hypothesized that these patients have a novel diagnosis, normokinetic biliary dyskinesia, and may have resolution of pain when treated with cholecystectomy.

Methods

A retrospective chart review was completed looking for patients with biliary pain in accordance with the ROME III criteria. Additional inclusion criteria were (1) greater than age 18 years, (2) reproducible biliary symptoms during the CCK-HIDA scan, and (3) an ejection fraction greater than 35 %. Treatment modality was laparoscopic cholecystectomy. Descriptive statistics were preformed, and data were reported as mean ± standard deviation and range.

Results

Nineteen patients met the inclusion criteria for this study from August 2008 to July 2011. There were 15 women and 4 men with a mean age of 48.4 ± 13.0 years. The mean ejection fraction was 75.1 ± 19.4 %. The average duration of preoperative symptoms was 6.8 ± 5.9 months and postoperative follow-up was 21.8 ± 10.6 months. Seventeen patients had complete resolution of symptoms, one had partial resolution, and one had no change. There was a complete resolution rate of 89.5 % and an improvement rate of 94.7 %.

Conclusions

We suggest that patients who present with biliary pain, a normal CCK-HIDA scan with an ejection fraction greater than 35 %, and with reproducible symptoms on infusion of CCK could have a novel diagnosis: normokinetic biliary dyskinesia. Currently, these patients are excluded from the diagnosis of biliary dyskinesia and thus treatment. We hypothesize a potential new diagnosis, suggest cholecystectomy as treatment, and recommend a prospective study design for further evaluation.
Literature
1.
Griffen WO, Bivins BA, Rogers EL, Shearer GR, Liebschutz D, Lieber A (1980) Cholecystokinin cholecystography in the diagnosis of gallbladder disease. Ann Surg 191:636–640PubMedCrossRef
2.
Drossman DA, Dumitrascu DL (2006) Rome III: new standard for functional gastrointestinal disorders. J Gastrointest Liver Dis 15(3):237–241
3.
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 166:672–675CrossRef
4.
Yost F, Margenthaler J, Presti M, Burton F, Murayama K (1999) Cholecystectomy is an effective treatment for biliary dyskinesia. Am J Surg 178:462–465PubMedCrossRef
5.
Patel N, Lamb J, Hogle N, Fowler D (2004) Therapeutic efficacy of laparoscopic cholecystectomy in the treatment of biliary dyskinesia. Am J Surg 187:209–212PubMedCrossRef
6.
7.
Hansel S, DiBase J (2010) Functional gallbladder disorder: gallbladder dyskinesia. Gastroenterol Clin N Am 39:369–379CrossRef
8.
Carr J, Walls J, Bryan L, Snider D (2009) The treatment of gallbladder dyskinesia based upon symptoms, results of a 2-year, prospective, nonrandomized, concurrent cohort study. Surg Laparosc Endosc Percutan Tech 19:222–226PubMedCrossRef
9.
Young S, Arregui M, Singh K (2006) HIDA scan ejection fraction does not predict sphincter of Oddi hypertension or clinical outcome in patients with suspected chronic acalculous cholecystitis. Surg Endosc 20:1872–1878PubMedCrossRef
10.
Canfield A, Hetz S, Schriver J, Servis H, Hovenga T, Cirangle P, Burlingame B (1998) Biliary dyskinesia: a study of more than 200 patients and review of the literature. J Gastrointest Surg 2:443–448PubMedCrossRef
11.
Fink-Bennett D, DeRidder P, Kolozsi W, Gordon R, Jaros R (1991) Cholecystokinin cholescintigraphy: detection of abnormal gallbladder motor function in patients with chronic acalculous gallbladder disease. J Nucl Med 32:1695–1699PubMed
12.
Fink-Bennett D, DeRidder P, Kolozsi W, Gordon R, Rapp J (1985) Cholecystokinin cholescintigraphic findings in the cystic duct syndrome. J Nucl Med 26:1123–1128PubMed
13.
Fink-Bennett D, DeRidder P, Kolozsi W, Gordon R, Rapp J (1984) Cholecystokinin (CCK) functional cholescintigraphy (FC) in patients suspected of acalculous biliary disease. J Nucl Med 25:10–12
14.
Fink-Bennett D, DeRidder P, Kolozsi W, Gordon R, Rapp J (1986) Cholecystokinin in acalculous biliary disease. J Nucl Med 27:882–884
15.
Krishnamurthy GT, Bobba VR, Kingston E, Turner F (1998) Measurement of gallbladder emptying sequentially using a single dose of 99mTc-labeled hepatobiliary agent. Gastroenterology 83:773–776
16.
Krishnamurthy GT, Bobba VR, Kingston E (1981) Radionuclide ejection fraction: a technique for quantitative analysis of motor function of the human gallbladder. Gastroenterology 80:482–490PubMed
17.
Ziessman HA, Muenz LR, Agarwal AK, ZaZa AA (2001) Normal values for sincalide cholescintigraphy: comparison of two methods. Radiology 221:404–410PubMedCrossRef
18.
Ziessman HA, Fahey FH, Hixson DJ (1992) Calculation of gallbladder ejection fraction: advantage of continuous sincalide infusion over the three-minute infusion method. J Nucl Med 33:537–547PubMed
19.
Ziessman HA (1990) Cholecystokinin cholescintigraphy: victim of its own success? J Nucl Med 40:2038–2042
20.
Lanzini A, Jazrawi RP, Northfield TC (1987) Simultaneous quantitative measurements of absolute gallbladder storage and emptying during fasting and eating in humans. Gastroenterology 92:852–861PubMed
21.
Jazrawi RP, Pazzi P, Petroni ML et al (1995) Postprandial gallbladder motor function: refilling and turnover of bile in health and cholelithiasis. Gastroenterology 109:582–591PubMedCrossRef
22.
Pallotta N, Corazziari E, Scopinato F et al (1998) Noninvasive estimate of bile flux through the gallbladder in humans. Am J Gastroenterol 93:1877–1885PubMedCrossRef
23.
Raymond F, Lepanto L, Rosenthal L, Fried GM (1998) Tc99mIDA gallbladder kinetics and response to CCK in chronic cholecystitis. Eur J Nucl Med 14:378–381
24.
Hopman W, Jansen J, Rosebusch G (1986) Gallbladder contraction induced by cholecystokinin: bolus injection or infusion. Br Med J 292:375–376CrossRef
25.
Harvy R, Read A (1973) Effect of cholecystokinin on colonic motility and symptoms in patients with irritable bowel syndrome. Lancet 1:1–3CrossRef
26.
Morris-Stiff G, Falk G, Kraynk L, Rosenblatt S (2011) The cholecystokinin provocation HIDA test: recreation of symptoms is superior to ejection fraction in predicting medium-term outcomes. J Gastrointest Surg 15:345–349PubMedCrossRef
27.
Westlake PJ et al (1990) Chronic right upper quadrant pain without gallstones: does HIDA scan predict outcome after cholescintigraphy? Am J Gastroenterol 85(8):986–990PubMed
28.
Ziessman H, Tulchinsky M, Maurer A (2011) Consensus report on standardization of sincalide cholescintigraphy. J Nucl Med 52:16CrossRef
29.
Dibaise JK, Richmond BK, Ziessman HA et al (2011) Cholecystinokinin-cholescintigraphy in adults: consensus recommendations of an interdisciplinary panel. Clin Gastroenterol Hepatol 9:376–384PubMedCrossRef
30.
Ziessman HA, Tulchinsky M, Lavely WC et al (2010) Sincalide-stimulation cholescintigraphy: a multicenter investigation to determine optimal methodology and gallbladder ejection fraction normal values. J Nucl Med 51:229–236CrossRef
31.
Riyad K, Chalmers C, Aldouri A, Fraser S, Menon K, Robinson P, Toogood G (2007) The role of 99mtechnetium-labelled hepato-imino-diacetic acid (HIDA) scan in the management of biliary pain. HPB 9:219–224PubMedCrossRef
32.
Das A, Baijal SS, Sawaswat DM (1995) Effect of aspirin on gallbladder motility in patients with gallstone disease. Dig Dis Sci 40:1782–1785PubMedCrossRef
33.
Bingener J, Richards ML, Schwesinger WH et al (2004) Laparoscopic cholecystectomy for biliary dyskinesia: correlation of preoperative cholecystokinin cholescintigraphy results with postoperative outcome. Surg Endosc 18:802–806PubMedCrossRef
34.
Carney DE, Kokoska ER, Grosfeld JL et al (2004) Predictors of successful outcome after cholecystectomy for biliary dyskinesia. J Pediatr Surg 39:813–816PubMedCrossRef
35.
Chen PF, Nimeri A, Pham QH et al (2001) The clinical diagnosis of chronic acalculous cholecystitis. Surgery 130:578–581PubMedCrossRef
36.
DiBaise JK, Oleynikov D (2003) Does gallbladder ejection fraction predict outcome after cholecystectomy for suspected chronic acalculous gallbladder dysfunction? A systematic review. Am J Gastroenterol 98(12):2605–2611PubMedCrossRef
37.
Patel NA, Lamb JJ, Hogle NJ et al (2004) Therapeutic efficacy of laparoscopic cholecystectomy in the treatment of biliary dyskinesia. Am J Surg 187(2):209–212PubMedCrossRef
38.
Sunderland GT, Carter DC (1998) Clinical application of the cholecystokinin provocation test. Br J Surg 75:444–449CrossRef
39.
Smythe A, Majeed AW, Fitzhenry M et al (1998) A requiem for the cholecystokinin provocation test? Gut 43(4):571–574PubMedCrossRef
40.
Adams D, Tarnasky P, Hawes R, Cunningham J, Brooker C, Brothers T, Cotton P (1998) Outcome after laparoscopic cholecystectomy for chronic acalculous cholecystitis. Am Surg 64:1–6PubMed
41.
Bar-Meir S, Halpern Z, Bardan E, Gilat T (1984) Frequency of papillary dysfunction among cholecystectomized patients. Hepatology 4:328–330PubMedCrossRef
42.
Neoptolemos JP, Bailey IS, Carr-Locke DL (1988) Sphincter of Oddi dysfunction: results of treatment by endoscopic sphincterotomy. Br J Surg 75:454–459PubMedCrossRef
43.
Murray WR (2011) Botulinum toxin-induced relaxation of the sphincter of Oddi may select patients with acalculous biliary pain who will benefit from cholecystectomy. Surg Endosc 25:813–816PubMedCrossRef
Metadata
Title
Normokinetic biliary dyskinesia: a novel diagnosis
Authors
Christopher DuCoin
Robert Faber
Marlon Ilagan
William Ruderman
Daryl Wier
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 11/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-012-2342-0

Other articles of this Issue 11/2012

Surgical Endoscopy 11/2012 Go to the issue

OriginalPaper

Hiatal hernia, Barrett’s esophagus, and long-term symptom control after laparoscopic fundoplication for gastroesophageal reflux

OriginalPaper

Should all endoscopically excised rectal polyps be tattooed? A plea for localization

OriginalPaper

Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases)

Dynamic Manuscript

Early experience of laparoscopic complete en bloc excision for choledochal cysts in adults

OriginalPaper

Novel endoscopic delivery modality of infrared coagulation therapy for internal hemorrhoids

OriginalPaper

Stenting versus gastrojejunostomy for management of malignant gastric outlet obstruction: comparison of clinical outcomes and costs