HPB P08 Is Biliary Hyperkinesia a true Pathology? Should cholecystectomy be considered? A prequel towards Pilot study

Abstract

Abstract Background Biliary Hyperkinesia (BH) is defined as a condition where gallbladder contracts and empties more rapidly than usual causing recurrent biliary colic with no evidence of gallstones on ultrasound or MRCP. Hepatobiliary iminodiacetic acid (HIDA) scan is the investigation of choice and shows gallbladder ejection fraction (EF) of >80% in BH. A recent systematic review and meta-analysis suggested that laparoscopic cholecystectomy (LC) could alleviate the symptoms. Similar results have been highlighted in case reports published about this relatively new gallbladder dysmotility. This study investigates the number of patients with BH on HIDA scan who might qualify for LC. Methods This was a 7-year (2015 to 2022) retrospective cohort study of adult patients with biliary pain in the absence of gallstones who underwent HIDA scan. Patient with EF >80% on HIDA scan were included in the study. Electronic case notes were reviewed for demographics, body mass index (BMI), smoking status, liver function tests, duration of symptoms, radiology investigations and endoscopy result including endoscopic ultrasound (EUS). Results 225 patients had HIDA scan of which 37 (16.4%) patients had BH. Median age was 49 years (IQR 38-62) and 32 (86.4%) were female. Median BMI 28 (IQR 23.3-32.4) and 48.3% were smokers. 5 (13.5%) were referred for pH manometry and gastric emptying studies while 25 (67.5%) have been formally discharged from surgery clinic follow-up. 7 (18.9%) are still waiting for further review. Only two patients had LC; one 3 years post HIDA when repeat ultrasound eventually showed gall stones and histopathology confirmed chronic cholecystitis. The second patient had sludge seen on EUS and histopathology confirmed chronic cholecystitis. Conclusions The hypothesis that overactive emptying of gallbladder represented by a high EF on HIDA scan leads to pain is somewhat convincing. High biliary pressure in a short circuit bounded by gallbladder/cystic duct junction and sphincter of Oddi causes gallbladder mucosal damage and cholecystitis. However, could there be missed stones or sludge is something that still needs to be considered. EUS might be of additional value before diagnosing patient with biliary hyperkinesia. Surgeons should consider LC in patients with BH once other pathologies have been ruled out. Further studies are needed to understand the outcome of cholecystectomy in BH.