Laparoscopic cholecystectomy for biliary dyskinesia in patient with an extended spectrum of ejection fraction on hepatobiliary iminodiacetic acid scan

Background: Biliary dyskinesia is a condition where the gallbladder motility is seen as abnormal. Diagnostic imaging studies for biliary dyskinesia usually include a negative or inconclusive abdominal ultrasound or computed tomography followed by a hepatobiliary iminodiacetic acid (HIDA) scan. The HIDA scan is used to visualize the gallbladder and access its motility. The motility is reported in the form of an ejection fraction (EF). Billiary dyskinesia is diagnosed if the EF is less than 35%. However, there are many patients with an EF of greater than 35% but are exhibiting all the signs and symptoms for biliary dyskinesia. Aim: This study evaluated the efficacy of laparoscopic cholecystectomy as a treatment modality in symptomatic patients diagnosed with biliary dyskinesia with three distinct HIDA scan EF results. Materials and methods: They were a total of 654 verified case of laparoscopic Cholecystectomy done between January, 2013 and December 2016 at Westlake and West Suburban Hospital. A total of 163 cases out of the 654 had HIDA scan with calculated EF, therefore meeting the criteria to be included in this study. The patients pre and post-operative course was reviewed from their medical records and resolution of symptoms was determined by in phone interview. Results: A total of 29 (18%) patients were lost to follow up. Out of the 99 cases interviewed in the first group (EF <35%) 91 (92%) cases reported complete symptom resolution post cholecystectomy. Out of the 18 cases interviewed in the second group (EF between 35%-50%) 13 (72%) cases reported complete resolution post cholecystectomy. Out of the 17 cases interviewed in the last group (EF> 75%) 11 (65%) cases reported complete resolution of their symptoms Conclusion: Our study indicates that patient suffering with symptomatic biliary dyskinesia and has a HIDA with EF less than 50% or EF greater than 75% will most likely benefit from laparoscopic Cholecystectomy and could be a reasonable option to offer symptomatic patients.