T1625 Is Pain Provocation With Cholecystokinin Administration on Cholescintigraphy Predictive of Relief of Symptoms for Biliary Dyskinesia Following Cholecystectomy?

Abstract

Introduction Biliary dyskinesia, also referred to as chronic acalculous gallbladder disease (CAGD), falls within the spectrum of diseases associated with gallbladder dysmotility. Cholecystokinin cholescintigraphy (CCK-CS) has been used to evaluate for CAGD, with a gallbladder ejection fraction (GBEF) of <35% being indicative of gallbladder dysfunction. The reproduction of biliary colic upon administration of CCK has been cited as indicative of CAGD. Our purpose was to determine if reproduction of pain during CCK-CS is a predictor of surgical outcomes or as a correlate to pathology. Methods A retrospective review of patients was performed to evaluate adults with a diagnosis of CAGD who underwent CCK-CS prior to surgical intervention. CPT and ICD-9 coding queries were used to identify the patient population. Patients with cholelithiasis were excluded. This study was approved by the institutional Human Assurances Committee. Results 64 patients met inclusion criteria. Two patients were lost to follow up and were excluded. During CCK administration, 41 patients (66.13%) reported symptoms similar to their presenting complaint. 21 patients reported no symptoms with CCK administration. Pathology review demonstrated either normal histology (n=4), cholesterolosis (n=4), chronic cholecystitis (n=47), both cholesterolosis and chronic cholecystitis (n=6), or autolysis (n=1). There was no significant relationship between pathology and either GBEF or reproduction of symptoms with CCK administration. 81% of patients (n=50) had relief of symptoms following cholecystectomy (mean EF of 19.55% ± 12.16%). 33 of these patients (66.00%) had reproduction of symptoms with CCK-CS. Twelve patients had recurrence of symptoms (mean EF of 17.18% ± 7.59%) despite surgery. Eight of these patients (66.67%) had symptom reproduction with CCK administration. There was no significant correlation with either the EF or reproduction of symptoms following CCK administration as a predictor of postoperative outcome on assessment by unpaired Student's t-test. Conclusion Provocation of pain CCK-CS is an unreliable indicator of postoperative relief of symptoms than GBEF.