The diagnosis and treatment of
biliary dyskinesia, defined as symptoms of biliary
colic in the absence of
gallstones, remains controversial and has been the subject of several previous retrospective reviews. The diagnosis and treatment of
biliary dyskinesia based on the CCK-
HIDA scan, and the outcome with
cholecystectomy for billary
dyskinesia, are reviewed. We add more than 200 cases of
cholecystectomy for
biliary dyskinesia, and compare our results with those of previous reports. We retrospectively reviewed 295 patients with
biliary dyskinesia who underwent
cholecystectomy at three military hospitals between 1988 and 1995. All patients had symptoms consistent with biliary
colic and preoperative evaluations that revealed no evidence of
cholelithiasis. Pathology specimens were reviewed for
cholelithiasis and pathologic changes. Data were retrieved by chart review and clinic evaluation of new patients. Individual follow-up of each patient was attempted. Follow-up was achieved in 218 of the 295 patients for a rate of 74%. The mean duration of follow-up was 506 days with a range of 22 days to 6 years. Two hundred patients (92%) had CCK-
HIDA scans with an ejection fraction (EF) >=<50%. Eighteen patients (8%) had an EF >50% but did have reproduction of their symptoms with CCK injection. In the group with an EF <50%, 94.5% were improved or cured with
cholecystectomy. In the group with an EF >50% and
pain reproduction, the improved or cured rate was 83.4%. CCK-
HIDA scans are useful for diagnosing
biliary dyskinesia and predicting improvement after
cholecystectomy. Patients presenting with
biliary dyskinesia and an EF <50% on CCK-
HIDA scan have 94% improvement or resolution of their symptoms after cholecystectorny. CCK-
HIDA scans should be employed early in the evaluation of billary
colic with no evidence of
cholelithiasis (i.e., with a normal ultrasound scan). When test results are abnormal,
cholecystectomy should be performed, since the results in this setting approach those of
cholecystectomy for stone disease (>90% cured/improved). In the current climate of cost containment, these excellent results would obviate the need for extensive and expensive medical testing before surgical
therapy is recommended.