PMID- 32632487 OWN - NLM STAT- MEDLINE DCOM- 20210929 LR - 20210929 IS - 1432-2218 (Electronic) IS - 0930-2794 (Linking) VI - 35 IP - 7 DP - 2021 Jul TI - Biliary hyperkinesia: an indication for cholecystectomy? PG - 3244-3248 LID - 10.1007/s00464-020-07757-4 [doi] AB - 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 EF (EF < 35%) is a recognized indication for cholecystectomy. Recent articles report long-term resolution of symptoms in children with high EFs on the HIDA scan. The purpose of this study is to evaluate the response of patients with biliary colic and hyperkinetic gallbladder to cholecystectomy. We suggest that laparoscopic cholecystectomy might be a considerable surgical option in a subset of the adult population whose workup for food-related biliary abdominal pain is negative except for the high-value EF on HIDA scan. METHODS: Data were consecutively collected from all patients who underwent laparoscopic cholecystectomy between June 2012 and June 2019 at a single institution. Cases were identified using Current Procedural Terminology codes. Patients older than 17 years of age with the negative US (no stone, no sludge, no gallbladder wall thickening) and EF greater than 80% on cholecystokinin (CCK)-HIDA scan were included in this study. All patients were seen at 2 weeks and 10-16 months after surgeries. RESULTS: Over 7 years from June 2012 until June 2019, of 2116 patients who underwent laparoscopic cholecystectomy, 59 patients (2.78%) met study criteria. Postprandial abdominal pain was the most common symptom (43, 72.90%) followed by nausea/vomiting. Forty-seven patients (74.6%) had a reproduction of symptoms with CCK infusion. The average EF was 88.51%. Final pathology showed chronic cholecystitis in 41 (69.5%) patients, cholesterolosis in 13 (22%), polyp in 2 (3.4%). Thirty-six (61%) patients had complete resolution of symptoms, 9 (15%) patients had partial resolution, and 14 (24%) patients had no change. There was a complete resolution rate of 61% and an improvement rate of 76%. CONCLUSIONS: In patients with biliary symptoms, negative ultrasound, and elevated EF on HIDA scan (EF > 80%), laparoscopic cholecystectomy led to a significant rate of symptomatic relief. Interestingly, 94% also had unexpected pathologic findings. This disease process requires further analysis, but this could represent a new indication for laparoscopic cholecystectomy in the adult population. FAU - Nasri, Baongoc AU - Nasri B AUID- ORCID: 0000-0002-5561-2624 AD - Department of Surgery, St Vincent Indianapolis, Indianapolis, IN, USA. Baongoc.nasri@ascension.org. FAU - Glass, Timothy AU - Glass T AD - Department of Surgery, St Vincent Indianapolis, Indianapolis, IN, USA. FAU - Singh, Kirpal AU - Singh K AD - Department of Surgery, St Vincent Indianapolis, Indianapolis, IN, USA. FAU - Saxe, Jonathan AU - Saxe J AD - Department of Surgery, St Vincent Indianapolis, Indianapolis, IN, USA. LA - eng PT - Journal Article DEP - 20200706 PL - Germany TA - Surg Endosc JT - Surgical endoscopy JID - 8806653 SB - IM MH - Adult MH - *Biliary Dyskinesia/diagnostic imaging/surgery MH - Child MH - Cholecystectomy MH - *Cholecystectomy, Laparoscopic MH - *Gallbladder Diseases/surgery MH - Humans MH - Hyperkinesis MH - Retrospective Studies MH - Treatment Outcome OTO - NOTNLM OT - Biliary hyperkinesia OT - Cholecystectomy OT - EF (ejection fraction) OT - HIDA scan EDAT- 2020/07/08 06:00 MHDA- 2021/09/30 06:00 CRDT- 2020/07/08 06:00 PHST- 2019/07/23 00:00 [received] PHST- 2020/06/23 00:00 [accepted] PHST- 2020/07/08 06:00 [pubmed] PHST- 2021/09/30 06:00 [medline] PHST- 2020/07/08 06:00 [entrez] AID - 10.1007/s00464-020-07757-4 [pii] AID - 10.1007/s00464-020-07757-4 [doi] PST - ppublish SO - Surg Endosc. 2021 Jul;35(7):3244-3248. doi: 10.1007/s00464-020-07757-4. Epub 2020 Jul 6.