Hepatobiliary scanning standards fail to identify symptomatic patients with chronic acalculous cholecystitis

Abstract

Background: Patients with chronic biliary colic-like pain and normal transabdominal ultrasonography (TUS) typically undergo nuclear hepatobiliary imaging (HIDA) with cholecystokinin (CCK) injection and gall bladder ejection fraction (EF) calculation to identify gallbladder dyskinesia. Most literature suggests EF£35% indicates biliarydyskinesia. We hypothesize that presence of chronic biliary colic-like symptoms predicts favorable outcome after cholecystectomy (CCY) in patients with normal hepatobiliary imaging.Methods: A retrospective review of 1295 patients who underwent laparoscopic CCY from January 2006 to December 2010 in a tertiary care institution was completed. Patients with gallstones on TUS or diagnostically abnormal HIDA scans were excluded. Symptom reproduction upon CCK injection was not considered for inclusion criteria but was noted upon chart review. Patient outcome, favorable or unfavorable, was determined from postoperative follow-up.Results: One hundred and six patients (8.19%) with normal TUS and HIDA scans were included in the final analysis. Ninety-six patients (90.6%) reported a favorable outcome (i.e., significant improvement or complete resolution of their symptoms) on follow-up. Ninety-three patients with favorable outcomes and six patients with unfavorable outcomes presented with an initial complaint of right upper quadrant (RUQ) and/or epigastric pain (p=0.001, sensitivity=95.9%, PPV=93.9%). Sixty-eight patients with favorable outcomes and one patient with an unfavorable outcome presented with an initial complaint of postprandial RUQ and/or epigastric pain (p<0.001, specificity=90.0%, PPV=98.6%).Conclusion: Hepatobiliary imaging fails to identify all patients suffering from chronic acalculous cholecystitis. Presence of chronic biliary colic-like symptoms predicts benefit from CCY.