Cholecystectomy Is an Effective Treatment for Biliary Dyskinesia Fredrick Yost, MD, Julie Margenthaler, MD, Michael Presti, MD, Frank Burton, MD, Kenric Murayama, MD, St. Louis, Missouri BACKGROUND: An increasing number of reports indicate symptomatic relief of biliary colic symp- toms after cholecystectomy for biliary dyskine- sia. Despite this, cholecystectomy as a treatment for biliary dyskinesia remains controversial. Our aim was to determine efficacy of cholecystec- tomy in alleviating biliary dyskinesia symptoms and the correlation with histologic findings. METHODS: Records of patients with gallbladder ejection fraction <35% between January 1994 and February 1999 were reviewed. Gallbladder pathology and degree of symptomatic improve- ment were determined on follow-up. RESULTS: Of the 27 cholecystectomy patients, 24 (89%) had significant improvement, 2 (7%) had partial improvement, and 1 (4%) had minimal im- provement. Ten patients (43%) had normal gall- bladder, and 9 (90%) of them had significant im- provement after cholecystectomy. Of the 6 nonsurgical patients, none had significant im- provement, 4 (67%) had partial improvement, and 2 (33%) had minimal improvement. CONCLUSIONS: Biliary dyskinesia patients who un- derwent cholecystectomy had significantly greater symptom improvement compared with nonsurgical patients. Pathologic correlation sug- gests chronic inflammation may not be the only cause of gallbladder dysfunction. Cholecystec- tomy should be a first-line therapy for biliary dyskinesia patients. Am J Surg. 1999;178:462– 465. © 1999 by Excerpta Medica, Inc. T he diagnosis of biliary dyskinesia or gallbladder dys- function is often not considered for patients who complain of symptoms suggestive of biliary colic and an ultrasound demonstrating no gallstones. Many patients undergo further testing with normal findings and are often given the diagnosis of “irritable bowel.” Increasing evi- dence suggests that these patients may have a physiologic disorder that causes abnormal gallbladder emptying and a concomitant pain syndrome. 1–5 Biliary dyskinesia is defined as the presence of biliary colic symptoms without cholelithiasis, and suggests the potential of chronic inflammation. Quantitative radionuclide scan- ning with cholecystokinin stimulation is currently used to determine abnormal gallbladder ejection fraction. Several studies have reported that patients with biliary dyskinesia documented by abnormal cholecystokinin hepatobiliary ra- dionuclide scan have relief of symptoms after cholecystec- tomy. 6 –11 Despite these reports, the role of cholecystec- tomy for treatment of biliary dyskinesia is not universally accepted. Since its advent, the laparoscopic approach to cholecys- tectomy has become the “gold standard” for treatment of gallbladder disorders. Although the number of cholecystec- tomies has increased with the use of laparoscopy, the role of cholecystectomy in the treatment of biliary dyskinesia has yet to be determined. Our aim, therefore, was to determine the efficacy of cholecystectomy in alleviating symptoms of biliary dyskinesia in our institution and to determine whether this diagnosis correlates with histologic findings of chronic cholecystitis. MATERIALS AND METHODS Medical records of patients with a gallbladder ejection fraction 35% on radionuclide scanning between January 1994 and February 1999 at St. Louis University Hospital were reviewed. Quantitative radionuclide scanning with cholecystokinin stimulation was used to determine the gallbladder ejection fraction. From these patients, we iden- tified those with normal ultrasounds with no evidence of gallstones or bile duct dilatation. Gallbladder pathology reports from patients who underwent cholecystectomy were reviewed. Degree of symptomatic improvement was determined on follow-up of patients in clinic or by phone interview using a subjective scale from 0% to 100%. These patients were divided into three categories: significant improvement (75%), partial improvement (25% to 75%), and minimal improvement (25%). The clinical outcomes were com- pared between surgical and nonsurgical groups using Fish- er’s exact test. Significance was determined at a P value 0.01. Technique of Quantitative Radionuclide Scanning With Cholecystokinin After an overnight fast, 5 mCi of technetium Tc 99m- diisopropyl iminodiacetic acid (DISIDA) was administered intravenously. Anterior images of the right upper quadrant were obtained every 5 minutes for 1 hour. The patient then received 0.03 mg/kg of cholecystokinin (CCK) intrave- nously and anterior images were obtained every 5 minutes for 30 minutes in order to study gallbladder contractility From the Department of Surgery (FY, JM, KM) and Division of Gastroenterology (MP, FB), Saint Louis University Health Sci- ences Center, St. Louis, Missouri. Requests for reprints should be addressed to Kenric M. Mu- rayama, MD, Department of Surgery, Northwestern University Medical School, 11-703 Tarry Building, 300 East Superior St., Chicago, Illinois 60611. Presented at the 51st Annual Meeting of the Southwestern Surgical Congress, Coronado, California, April 18 –21, 1999. 462 © 1999 by Excerpta Medica, Inc. 0002-9610/99/$–see front matter All rights reserved. PII S0002-9610(99)00228-7