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The Treatment of Biliary Dyskinesia Based Upon Symptoms: Results of a One-Year Prospective Study
John Alfred Carr, LaDonna Bryan, Donald Snider
Passavant Surgical Associates, Jacksonville, IL
Objective: To determine the success rate of cholecystectomy or observation in treating patients with biliary dyskinesia (BD), with intervention based upon presenting symptoms.
Design: A one-year prospective study.
Setting: Community hospital.
Patients: 54 consecutive patients with documented BD, defined as cholecystokinin-stimulated (CCK) ejection fraction (EF) < 35% on nuclear cholescintigraphy and a negative gallbladder ultrasound.
Interventions: Based upon presenting symptoms and their severity, patients either underwent cholecystectomy, observation, or additional testing.
Main Outcome Measures: Relief of symptoms.
Results: Classic biliary symptoms were identified in 36 patients and an atypical presentation occurred in 15 patients. Two patients with sludge and one with small stones were excluded. The gallbladder EF with CCK stimulation was significantly higher in those with classic symptoms (20 + 10 vs 13 + 7%, p = 0.02). Of those with atypical symptoms, 47% (7/15) had resolution of their symptoms without surgery after a mean of four weeks. Forty percent (6/15) had persistent symptoms which did not resolve on their own but did resolve after cholecystectomy, and 13% (2/15) had no improvement after surgery. Of those with classic symptoms, 35 patients underwent laparoscopic cholecystectomy with resolution of symptoms in all thirty-five. One patient refused surgery (surgical success 35/35, 100%, overall 35/36, 97%).
Conclusions: Classic biliary symptoms are an indication for cholecystectomy in patients with BD, with an excellent success rate. The presence of a low EF alone, without any symptoms, is not an indication for surgery. Patients with a low EF and atypical symptoms may improve after a mean observation period of four weeks, but persistent symptoms should prompt intervention.
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