Abstracts
1999 Digestive Disease Week

# 2073 BILIARY HYPERKINESIA: A NEW INDICATION FOR CHOLECYSTECTOMY
C H Cook, Ohio State Univ Med Ctr, Columbus, OH; J Kisner, Ohio State Univ, Columbus, OH; W S Melvin, J Olsen, R Pozderac, L C Martin, Ohio State Univ Med Ctr, Columbus, OH

Background: Diagnosis and treatment of acalculous biliary disease has been significantly improved with nuclear medicine cholescintigraphy and measurement of cholecystokinin (CCK) induced gall bladder ejection fraction (GBEF). Current data supports surgical therapy for patients with biliary hypokinesia, but there is no data for patients with very high GBEF (>80%). We undertook this study to define whether biliary hyperkinesia (GBEF>80%) is a disease process that will respond favorably to surgical therapy. Methods: We reviewed all 200 patients who underwent nuclear medicine cholescintigraphy with CCK-GBEF after negative ultrasound studes between 1/95 and 7/98. Patients with GBEF >80% were studied by chart review and follow-up telephone survey. Results: Eighteen patients (9%) had biliary hyperkinesia documented during the study period. Fourteen patients were available for study. Seven have undergone laparoscopic cholecystectomy (LSC) while seven received non-operative therapy (NORx). All patients (100%) who underwent LSC had complete remission (79%) or significant improvement (21%) in their symptoms, while no patients undergoing NORx had symptomatic relief. There was no significant difference between groups in patient age, GBEF, or time (months) until follow up. Incidence of presenting symptoms including RUQ pain (64%), epigastric pain (21%), back pain (7%), nausea/vomiting (64%), fatty food intolerance (79%), or bowel irregularity (50%) were also not significantly different between the LSC and Norx groups. Conclusions: Biliary hyperkinesia (GBEF>80%) is a disease that seems to respond favorably to surgical therapy. The pathophysiologic mechanism for this is not known. We recommend cholecystectomy for symptomatic patients with biliary hyperkinesia.

	LSC	NORx	P value
Symptom relief	7/7	0/7	.0006
Age (yrs)	49.7	51.3	0.79
Mean GBEF	84.6	84.9	0.62
Follow up (mo's)	19.3	26.3	0.32

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