CHOLECYSTECTOMY ALLEVIATES ACALCULOUS BILIARY PAIN IN PATIENTS WITH AREDUCED GALLBLADDER EJECTION FRACTION

Background. We sought to determine whether a reduced gallbladder eject ion fraction, (GBEF) ascertained by cholecystokinin-cholescintigraphy (CCK-CS), predicts symptomatic improvement after cholecystectomy. Meth ods, Medical records of patients who bad had CCK-CS as well as negativ e results of gallbladder ultrasonography were reviewed, and patients w ere contacted by telephone to determine whether they had benefited fro m cholecystectomy. Results, There were 35 patients (33 female, 2 male) who had a decreased GBEF. Cholecystectomy was done in 30, of whom 20 (67%) had resolution of pain, 8 (27%) had partial improvement, and 2 ( 7%) had no change. The 5 who declined cholecystectomy included none (0 %) who were pain free, 2 (40%) who had partial improvement, and 3 (60% ) who had no change. The clinical outcome of the two groups was signif icantly different. There were 14 patients (10 female, 4 male) with a n ormal GBEF. The 2 patients who had cholecystectomy were asymptomatic. Of the 12 patients who did not have cholecystectomy, 9 (75%) were asym ptomatic, 1 (8%) had some improvement, and 2 (17%) had no change. Conc lusions. Cholecystectomy is indicated for patients with acalculous bil iary pain and reduced GBEF, since symptoms will likely resolve with su rgery and will persist without it. Cholecystectomy for patients with a normal GBEF should be considered only after failure of a nonoperative trial, since improvement usually occurs over time.