Purpose: Controversy exists whether biliary dyskinesia is best treated with cholecystectomy. Gallbladder dysmotility and bile stasis are factors associated with gallstones, therefore biliary dyskinesia should be considered part of the spectrum of gallbladder pathophysiology. The purpose of this study was to compare outcomes after cholecystectomy in patients with atypical abdominal pain and decreased gall bladder ejection fraction (GBEF) as a measure of biliary dyskinesia who either did not or did exhibit gallstones on preoperative radiology exams and to support biliary dyskinesia as part of the spectrum of gallbladder disease.
Methods: From 1999 to 2006 at NYU Medical Center, 195 adult patients underwent hepatobiliary scintigraphy with cholecystokinin administration to evaluate GBEF. 116 displayed decreased GBEF (defined as <= 35%). Of these 116 patients, 36 underwent cholecystectomy. Chart review and telephone questionnaires were conducted of these 36 patients to determine which patients had gallstones diagnosed pre-operatively and symptom improvement after cholecystectomy. Statistical analysis was conducted using the Fisher exact test with a two-tail p-value.
Results: Complete follow-up was available for 32 of 36 patients with decreased GBEF and subsequent cholecystectomy. 20 patients (Group 1) had no gallstones diagnosed before cholecystectomy and therefore had pre-operative diagnosis of biliary dyskinesia; 12 patients (Group 2) demonstrated gallstones before cholecystectomy. Of Group 1, 19 improved symptomatically after surgery (95.0%). 4 of these 20 patients (20.0%) demonstrated stones on pathology despite negative radiologic exams, and all four improved after surgery. Of Group 2, 10 improved after cholecystectomy (83.3%). 4 of these 10 patients (40.0%) did not demonstrate stones on pathology, and all four improved after surgery. There was no statistical significance in outcome between the two groups of patients (p = 0.62). Overall, 16 of 32 (50.0%) patients with decreased GBEF and subsequent cholecystectomy were diagnosed with gallstones at some point in treatment.
Conclusions: Standard of care for patients with symptomatic gallstones is cholecystectomy as it relieves symptoms and prevents complications. This study demonstrates symptomatic improvement in patients with atypical abdominal pain and decreased GBEF regardless of the presence of pre-operatively diagnosed gallstones. This similarity in outcome suggests that biliary dyskinesia should be considered as part of a spectrum of gallbladder disease.