CHOLESTEROLOSIS IN PATIENTS WITH CHRONIC ACALCULOUS BILIARY PAIN

The outcome of patients with cholesterolosis was compared with that of those with chronic cholecystitis operated on for chronic acalculous b iliary pain. A total of 55 patients with acalculous biliary pain with a median symptom duration of 24 (range 6-120) months were investigated by dynamic cholescintigraphy and followed for a median of 24 (range 1 2-60) months. Thirty-five patients underwent cholecystectomy, of whom 22 had a low gallbladder ejection fraction (under 35 per cent), with s ymptomatic improvement in 21 of these (P < 0.01). All four patients wi th a normal ejection fraction (35-50 per cent) improved after cholecys tectomy but only four of nine with a high ejection fraction (over 50 p er cent) did so. Results of histological examination were available in 32 patients and revealed cholesterolosis in 20. A low ejection fracti on was found in 16 patients with cholesterolosis, of whom 15 showed sy mptomatic improvement after cholecystectomy; the other four patients h ad a high fraction and all improved after cholecystectomy. Overall, sy mptoms in 19 of 20 patients with cholesterolosis improved after cholec ystectomy compared with only seven of 12 with chronic cholecystitis (P = 0.03).