Biliary Dyskinesia Research Articles

Functional Disorders of the Biliary Tract and Cholelithiasis: Analysis of a Possible Relationship

Aim: Diagnostic criteria for functional disorders of the biliary tract are presented in the materials of the Rome IV consensus, as well as expert councils of Russian and foreign specialists. Episodes of functional biliary pain are caused by a violation of bile outflow through the cystic duct and sphincter of Oddi. It has been suggested that there is a “biliary continuum” in which in some patients’ biliary dysfunction is transformed into cholelithiasis. Key points. Lithogenic bile is considered as the pathophysiological basis for the development of biliary dyskinesia and cholelithiasis. Lithogenic bile provokes inflammation of low grades in the mucous membrane of the biliary tract, decreased contractility of the gallbladder and impaired relaxation of the biliary sphincters, impaired physiological response to cholecystokinin. Changes in motility of the biliary tract may be associated with the influence of hydrophobic bile salts and impaired eicosanoid metabolism. Hyperplasia of the epithelium and muscle layer, hypersecretion of mucin and cholesterol precipitation further impair the outflow of bile. Experimental data and some clinical observations indicate the possibility of transformation of biliary dysfunction into cholelithiasis. Dysfunction of the sphincter of Oddi is one of the possible consequences of cholecystectomy and, in fact, acts as a variant of postcholecystectomy syndrome. The basis for the treatment of biliary dysfunctions are antispasmodics of different classes, which can be combined with ursodeoxycholic acid. The biliary tract-selective antispasmodic hymecromone has shown high effectiveness in relieving biliary pain, which also has a moderate choleretic effect and the ability to prevent the crystallization of cholesterol in bile and can be used both for functional diseases and for cholelithiasis. The domestic drug hymecromone “Odecromone” entered the pharmaceutical market. Conclusion. There is no doubt that the relevance of further study of the patterns of development of biliary dysfunctions and GI is obvious. The study of this problem will contribute to the development of effective preventive approaches, including in the field of nutraceuticals.

Concomitant Diseases in Pregnant Women Suffering with Chronic Viral Hepatitis B and C

The work identified concomitant diseases in 120 pregnant women suffering from chronic viral hepatitis B and C (CHB and CHC), aged 19 to 30 years. In the structure of extragenital pathology, the largest percentage belongs to diseases of the gastrointestinal tract, which was detected in 71.0% of 69 patients with CHB, in 76.5% of 51 pregnant women with CHC and in 42.1% of 57 relatively healthy pregnant women. Among the nosological forms were mainly chronic gastritis, chronic gastroduodenitis, biliary dyskinesia and chronic pancreatitis. Chronic viral hepatitis in pregnant women determines a high incidence of gastrointestinal tract damage due to biliary dyskinesia, apparently associated with viral liver damage. Urogenital infections among pregnant women are significantly more common in patients with CHB (59.4%) and CHC (80.3%) (p <0.05) than in those without liver pathology (21.5%). Among the urogenital infections, the most common was a combination of chlamydia and candidiasis, and less frequently, trichomonas infection, and only one patient was diagnosed with syphilis. Chronic viral hepatitis is a factor contributing to the development of urogenital infection in pregnant women.

The Management of Dysfunctional Gallbladder Disease and the Role of Laparoscopic Cholecystectomy on Symptom Improvement: A Retrospective Cohort Study.

Background Biliary dyskinesia (BD) is a disorder characterised by abdominal pain of biliary origin (i.e., sudden steady pain at the right upper quadrant of the abdomen or the epigastrium, the absence of gallstones on ultrasound (US)), and a decreased gallbladder ejection fraction (GBEF) on a cholecystokinin-cholescintigraphy hepatobiliary iminodiacetic acid (CCK-HIDA) scan. Patients experiencing symptoms suggestive of biliary obstruction, but lacking gallstones, yet exhibiting abnormal gallbladder emptying, may find therapeutic benefit from laparoscopic cholecystectomy. Common symptoms include recurrent, intense, and enduring pain, often exacerbated by fatty food consumption, localised in the upper right quadrant or epigastric region. This pain may radiate to the back or shoulder, persisting for at least 30 minutes but not exceeding several hours, and it is sometimes accompanied by nausea and vomiting. Abnormal gallbladder emptying is typically indicated by a GBEF below 35% on cholescintigraphy following cholecystokinin administration. Objective This study represents a single-centric review focusing on 88 patients over a five-year period who presented with features of dysfunctional gallbladder and underwent cholescintigraphy. The primary aim was to identify whether there is any role for laparoscopic cholecystectomy in symptom improvement among these patients. Methods This was a retrospective cohort study involving data collection using electronic medical records. Eighty-eight patients who underwent the HIDA scan between January 2019 and December 2023 at Wirral University Teaching Hospital NHS Foundation Trust (WUTH) were identified and separated into two groups, either hypofunctioning gallbladder (EF<35% ) or hyperfunctioning gallbladder (EF>80%). Normal HIDA scan patients (EF between 35%-80%) were excluded. The frequency of laparoscopic cholecystectomy and subsequent symptom improvement were recorded. Results Fifty-one patients were diagnosed with gallbladder dyskinesia (BD). Of these, 36 patients (30 females, mean age 43) were diagnosed with hypofunctional gallbladder (EF<35%), where 17 patients underwent laparoscopic cholecystectomy, resulting in symptom improvement in 10 patients (58.8%). Conversely, 15 patients were diagnosed with hyperfunctional gallbladder (13 females, mean age 48.6). Only two patients (13%) underwent laparoscopic cholecystectomy with 100% symptom improvement in both patients. Conclusions In conclusion, our retrospective study highlights the significance of the HIDA scan in identifying gallbladder hypofunction among patients presenting with biliary symptoms. The findings establish the efficacy of laparoscopic cholecystectomy as a management approach, with a notable proportion of patients experiencing symptom improvement (58.8%). These results contribute to our understanding of biliary dysfunction management and emphasise the importance of individualised treatment strategies for optimal patient outcomes. Further, randomised controlled trials (RCTs) are warranted to validate these findings and explore additional factors influencing symptom resolution in this patient population.

969 Assessment of Diagnostic Criteria and Treatment Approaches for Biliary Dyskinesia: A Retrospective Analysis in NHS Grampian

Abstract Aim Biliary dyskinesia is a motility disorder of the gallbladder and sphincter of Oddi which presents with biliary-type pain without a structural pathology. Diagnosis relies on the ROME IV criteria for Functional Gallbladder Disorder, but its clinical utilisation remains limited. This retrospective study evaluates the diagnostic criteria, investigations, treatment, and surgical outcomes in patients with suspected biliary dyskinesia. Method Data from 185 patients who underwent cholecystokinin cholescintigraphy between 2017 and 2022 in NHS Grampian were analysed. Information on patient demographics, Rome IV criteria, supportive investigations, treatments, complications, hospital admissions, and medication use was collected from Trakcare. Results The average patient age was 46 years, with 21.1% male and 78.9% female participants. The Rome IV Criteria was used in only 12.4% of cases. Cholecystectomy was performed in 40.5% of cases, with complications occurring in 10.6% of these surgeries. On average, patients were admitted to the hospital 1.07 times, staying for approximately 3.92 days before surgery. Notably, 30.6% of cholecystectomy patients needed readmission for unresolved symptoms, and 40.5% relied on analgesics. Conclusions Rome IV criteria was underutilised in diagnosing biliary dyskinesia. Cholecystectomy did not reliably relieve symptoms in all patients, resulting in repeat admissions. Better adherence to diagnostic criteria and clear treatment guidelines are needed.

Hyperkinetic Biliary Dyskinesia: An Underrecognized Problem With Good Surgical Outcomes After Cholecystectomy.

Introduction While surgical indications for symptomatic cholelithiasis and biliary hypokinesia are clear, hyperkinetic biliary dyskinesia (HBD) is an underrecognized condition with poorly defined symptomology and management guidelines. HBD is typically defined as a gallbladder ejection fraction (EF) ≥ 80% on a hepatobiliary iminodiacetic acid (HIDA) scan. We aimed to identify the prevalence and radiographic reporting of HBD, physician referral patterns, and clinical outcomes following cholecystectomy. Methods A retrospective cohort study of patients with HIDA scans completed over 21 years at our tertiary care hospital was performed. Demographics, symptomatology, referral patterns, and operative data were collected. HBD was defined as HIDA EF ≥80%. Patients with HBD who underwent cholecystectomy were analyzed. ANOVA and chi-square tests were used to compare variables among patients with or without symptom improvement using Statistical Product and Service Solutions (SPSS;IBM SPSS Statistics for Windows, Armonk, NY). Results Of 1,997 patients (73% female, mean age 51.7 years) who had HIDA scans with reported EF, 730 (36.6%) had an EF≥80%. Only 13.7% of HIDA scans with EF≥80% were reported as hyperkinetic, and the rest are "normal". Cholecystectomy was performed in 57 (7.8%) patients with EF≥80%, most being elective (89.5%) and all minimally invasive. Primary care physicians (PCPs) referred most elective cases to surgery (61.4%). The median time from HIDA to cholecystectomy was 146 days. Chronic cholecystitis was common in pathology (82.5%), while 38.6% had cholelithiasis. Overall, 53 patients (93.0%) reported symptom improvement at a median follow-up of 17.0 days. Patients without improvement had a higher prevalence of chronic gastrointestinal conditions (p<0.05), but not significantly more cholelithiasis, cholecystitis, time to surgery, or elective surgery status. Conclusions HBD is common but often underdiagnosed and thus likely underrecognized by treating physicians. Most HBD patients benefit from cholecystectomy, regardless of cholelithiasis. Patients with persistent symptoms after cholecystectomy may have confounding gastrointestinal diagnoses. Increased awareness among radiologists, referring PCPs, gastroenterologists, and surgeons about HBD and postoperative outcomes is needed to ensure that HBD is adequately treated.

Gene expression of antimicrobial peptides in rat intestine under conditions of chronic stress

BACKGROUND: Severe stress causes an array of dysfunctions in the immune, neuroendocrine, cardiovascular, digestive and other systems, resulting in an emergence of various types of pathology. Common manifestations of a chronic stress are the disorders in the gastrointestinal tract, such as irritable bowel syndrome, functional dyspepsia, biliary dyskinesia, dysbiosis, inflammatory processes that determine the development of gastritis and one of the most widespread post-stress pathologies of the gastrointestinal tract — stomach ulcers. The disclosure of the molecular mechanisms of a pathogenesis of diseases associated with gastrointestinal dysfunction related to chronic stress as well as a search for new ways to correct these disorders are important tasks of fundamental and clinical medicine. The present work is focused on evaluating a participation of molecular factors of the innate immunity in intestine, such as antimicrobial peptides secreted by intestinal epithelial cells upon infection, in a response to the chronic stress. AIM: The aim of the study was to estimate the gene expression of a number of antimicrobial peptides: intestinal α- and β-defensins of laboratory animals (rats) under chronic stress conditions. MATERIALS AND METHODS: Modeling of a chronic stress was performed by daily forced swimming of laboratory animals in cold water. An expression of α- and β-defensin genes was evaluated using a real-time polymerase chain reaction. RESULTS: We found an increase in the level of expression of the rat α-defensin-5 and β-defensin-3 genes in response to chronic stress, while the expression of β-defensin-2 gene was not changed compared to the control. CONCLUSIONS: Considering that changes in the concentration and spectrum of peptides with antibacterial activity, caused by prolonged stress, can contribute to modification of the composition of the intestinal microbiota, the data obtained can expand our understanding of the molecular basis of the pathogenesis of diseases associated with disorders in the composition of microbiota under stress.

Impact of Gut–Brain Axis on Hepatobiliary Diseases in Fetal Programming

The hepatobiliary system is vital for the biotransformation and disposition of endogenous molecules. Any impairment in the normal functioning of the hepatobiliary system leads to a spectrum of hepatobiliary diseases (HBDs), such as liver cirrhosis, fatty liver, biliary dyskinesia, gallbladder cancer, etc. Especially in pregnancy, HBD may result in increased maternal and fetal morbidity and mortality. Maternal HBD is a burden to the fetus’s growth, complicates fetal development, and risks the mother’s life. In fetal programming, the maternal mechanism is significantly disturbed by multiple factors (especially diet) that influence the development of the fetus and increase the frequency of metabolic diseases later in life. Additionally, maternal under-nutrition or over-nutrition (especially in high-fat, high-carbohydrate, or protein-rich diets) lead to dysregulation in gut hormones (CCK, GLP-1, etc.), microbiota metabolite production (SCFA, LPS, TMA, etc.), neurotransmitters (POMC, NPY, etc.), and hepatobiliary signaling (insulin resistance, TNF-a, SREBPs, etc.), which significantly impact fetal programming. Recently, biotherapeutics have provided a new horizon for treating HBD during fetal programming to save the lives of the mother and fetus. This review focuses on how maternal impaired hepatobiliary metabolic signaling leads to disease transmission to the fetus mediated through the gut–brain axis.

Biliary dyskinesia. Increasing in Incidence or Better Recognition?

Gallbladder disease has historically remained uncommon in children. Children with nausea, abdominal pain and vomiting after eating are more likely to be diagnosed with irritable bowel syndrome. When children are evaluated with laboratory studies, ultrasound of gallbladder and HIDA scan, a diagnosis of biliary dyskinesia may be confirmed. Laparoscopic surgery of the gallbladder has been shown to be effective with minimal recovery and complications. Follow-up shows that children unlike adults generally remain symptom-free.

The role of intestinal microbiota in the development of dysfunction of the biliary system in children

Objective: to study the state of the intestinal and biliary microbiota in children with intestinal and gallbladder dysfunction and to determine the features of the component composition of the biliary microbiota. Methods: We examined 20 children with irritable bowel syndrome (IBS). The presence of small intestinal bacterial overgrowth (SIBO) syndrome was determined (using a hydrogen breath test with lactulose), microbial markers of the intestinal and biliary microbiota (using gas chromatography-mass spectrometry). We also performed microscopy of bile (phase-contrast light microscopy) obtained through duodenal intubation. Results: In all children with IBS, SIBO was verified in the small intestine, with insufficiency of the ileocecal valve in half of them, associated with hypomotor dyskinesia of the gallbladder. Microscopy of the bile revealed a large number of crystals and leukocytes. A study of microbial markers of intestinal and biliary microbiota in all children with IBS and SIBO revealed excessive bacterial associative growth of gram-negative opportunistic bacteria in combination with viruses of the Herpes family. An increase in the level of lipopolysaccharides (2 times higher than normal) and a deficiency of microbial markers of the main groups of microorganisms (anaerobic bacteria) responsible for metabolization processes in the enterohepatic circulation (plasmalogen less than 50 μg/ml) were recorded. Excessive growth of 28 species of opportunistic bacteria was detected in bile in diagnostically significant concentrations associated with hypomotor dysfunction of the gallbladder and lithogenicity of bile. Conclusion: A violation of the biliary microbiota was established with an increase in the proportion of gram-negative opportunistic bacteria, the spectrum of which was close to that of the intestine and their association with intestinal and biliary dyskinesia

Diseases of the Biliary System in Children with Type 1 Diabetes Mellitus

The course of type 1 diabetes in childhood and its prognosis generally depends on the degree of development of metabolic disorders and the functional state of internal organs, in particular the state of the biliary system. The study was conducted at the National Center for Maternal and Child Health. 69 children aged 5 to 17 years with type 1 diabetes mellitus and damage to the biliary system in the form of biliary dyskinesia and hepatic steatosis were examined. As a result of the study, it was revealed that the development and progression of diseases of the biliary system in children with type 1 diabetes mellitus have a direct relationship with the degree of metabolic disorders, in particular with disorders of carbohydrate metabolism.

Comparison of laparoscopic cholecystectomy in children at paediatric centres and adult centres: a systematic review and meta-analysis.

Paediatric laparoscopic cholecystectomy (LC) is performed by both paediatric and adult surgeons. The aim of this review was to compare outcomes at paediatric centres (PCs) and adult centres (ACs). A literature search was conducted, in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, for papers published between January 2000 and December 2020. Statistical analysis was performed using Stata® version 16 (StataCorp, College Station, TX, US). A total of 92 studies involving 74,852 paediatric LCs met the inclusion criteria. Over half (59%) of the LCs were performed at ACs. No significant differences were noted in the male-to-female ratio, mean age or mean body mass index between PCs and ACs. The main indications were cholelithiasis (34.1% vs 34.4% respectively, p=0.83) and biliary dyskinesia (17.0% vs 23.5% respectively, p<0.01). There was no significant difference in the median inpatient stay (2.52 vs 2.44 days respectively, p=0.89). Bile duct injury was a major complication (0.80% vs 0.37% respectively, p<0.01). Reoperation rates (2.37% vs 0.74% respectively, p<0.01) and conversion to open surgery (1.97% vs 4.74% respectively, p<0.01) were also significantly different. Meta-analysis showed no significant difference in overall complications (p=0.92). The number of LCs performed, intraoperative cholangiography use and conversion rates were higher at ACs whereas bile duct injury and reoperation rates were higher at PCs. Despite a higher incidence of bile duct injury at PCs, the incidence at both PCs and ACs was <1%. In complex cases, a joint operation by both paediatric and adult surgeons might be a better approach to further improve outcomes. Overall, LC was found to be a safe operation with comparable outcomes at PCs and ACs.

A clinical case of Urbach-Wiethe disease

A clinical description of Urbach – Wiethe disease (lipoid proteinosis), an extremely rare pathology, is presented, currently only 300 cases are known. This hereditary disease, transmitted by an autosomal recessive type, is associated with a mutation of the extracellular matrix 1 (ECM1) gene located on chromosome 1, locus 1q21. It is based on a violation of collagen synthesis and deposition of hyaline in the dermis along the collagen fibers, in the mucous membranes, sometimes in the internal organs. The chemical composition of hyaline is not completely determined; it is noted that it includes collagen, glycoproteins, lipids, proteoglycans. The disease begins in early childhood and is characterized by changes in the ENT organs and skin, confirmed by histological examination, which reveals thickening of the dermis, degeneration of collagen fibers, hyalinosis with deposition around the vessels, in their walls, around the sweat glands of ribbon-like, weakly eosinophilic, homogeneous substances, which include phospholipids, sometimes there may be cracks with deposition of lipids.&#x0D; Patient V., born in 1990, the disease began almost from birth with the appearance of polymorphic rashes on the skin and hoarseness of the voice. In 1999, a histological examination of the affected skin was performed, confirming the diagnosis of lipoid proteinosis of Urbach – Wiethe. The skin pathological process is widespread, symmetrical, on the face it is represented by reticulated telangiectatic erythema, along the edge of the lower eyelids there are miliary nodules similar to a string of pearls. Hypoplasia and stagnant erythema of the auricles are determined. There are yellowish lenticular papules on the trunk and limbs, waxy translucent plaques of a dense consistency in the area of the extensor surface of the elbow joints. Besides, secondary hyperpigmentation and foci of atrophy were detected on the face, trunk and limbs. Skin changes are accompanied by lesion of the ENT organs in the form of bilateral maxillary sinusitis, frontitis, chronic pharyngitis, chronic laryngitis. Concomitant pathology is important: polyvalent sensitization, chronic hepatitis B, biliary dyskinesia against the background of gallbladder deformation, chronic gastroduodenitis. The patient has been on disability since 2000, needs dispensary supervision and correction of all identified violations.

Cholecystokinin and cholecystokinin-A receptor: An attractive treatment strategy for biliary dyskinesia?

Biliary dyskinesia is a relatively common gastrointestinal disease that is increasing in incidence as living standards improve. However, its underlying pathogenesis remains unclear, hindering the development of therapeutic drugs. Recently, "Expression and functional study of cholecystokinin-A receptors on the interstitial Cajal-like cells of the guinea pig common bile duct" demonstrated that cholecystokinin (CCK) regulates the contractile function of the common bile duct through interaction with the CCK-A receptor in interstitial Cajal-like cells, contributing to improving the academic understanding of biliary tract dynamics and providing emerging directions for the pathogenesis and clinical management of biliary dyskinesia. This letter provides a brief overview of the role of CCK and CCK-A receptors in biliary dyskinesia from the perspective of animal experiments and clinical studies, and discusses prospects and challenges for the clinical application of CCK and CCK-A receptors as potential therapeutic targets.

Traumatic gallbladder rupture in a 9-year-old child

We present gallbladder rupture following trauma. A 9-year-old boy admitted in 1.5 hours after injury. Considering clinical and ultrasound data, we diagnosed traumatic damage to the spleen and hemoperitoneum, biliary dyskinesia, cholestasis, sludge. Hemostatic therapy was carried out. After 3 days, signs of peritonitis appeared. Follow-up ultrasound revealed gallbladder enlargement with heterogeneous content, fluid in all parts of abdominal cavity. Intraoperatively, the gallbladder was enveloped in omentum soaked in bile. After mobilization of the gallbladder, we found longitudinal linear tear up to 3 cm clogged with omentum. Cholecystectomy was performed. Thus, we present a patient with combined injury and damage to the spleen. However, gallbladder wall thickening and heterogeneous content were interpreted as concomitant pathology. Delayed manifestation of peritonitis was due to gallbladder enveloped in omentum. The last one soaked in bile partially entered the gallbladder through perforation and prevented bile leakage into abdominal cavity. Timely diagnosis of gallbladder damage presents certain difficulties, especially in case of combined injury. Ultrasound signs of traumatic gallbladder rupture in this case were wall thickening, heterogeneous content and gradual gallbladder enlargement. It is necessary to analyze all organs at the damage site including computed tomography in patients with combined trauma.

Negative workup? Laparoscopic cholecystectomy Still alleviates symptoms

BackgroundStudies have shown that patients with abdominal pain and biliary dyskinesia (low ejection fraction <35 ​%) have significant improvement of symptoms following laparoscopic cholecystectomy, but there is lack of evidence that demonstrates whether patients with biliary symptoms and a normal ejection fraction (>35 ​%) will have similar results. MethodsRetrospective, single center study of patients with biliary pain and negative workup, including HIDA with EF>35 ​%, who were treated with laparoscopic cholecystectomy from 2017 to 2022. ResultsThere were 117 total patients. The mean age was 45.49 ​± ​15.5 years and 101 (86 ​%) were female. 101 (86 ​%) of patients underwent a right upper quadrant ultrasound, 91 had normal findings, 9 difficult to visualize anatomy and 1 had adenomyomatosis. All patients had a normal HIDA scan and ejection fraction 104 (89 ​%) of patients followed up in clinic within 30 days of surgical intervention. 87 (84 ​%) reported resolution of pre-operative symptomatology after surgical intervention. There was no statistically significant correlation between pain with CCK administration during HIDA (p ​= ​0.803) scan or ejection fraction (p ​= ​0.0977) with resolution of symptoms. ConclusionsLaparoscopic cholecystectomy appears to be a beneficial intervention for patients with abdominal pain and normokinetic biliary disease. Offering surgical intervention early on can potentially save patients from exhaustive diagnostic investigations and possibly misdiagnosis.

Enhanced Recovery after Surgery Applied to Pediatric Laparoscopic Cholecystectomy for Simple Cholelithiasis: Feasibility and Teaching Insights.

Same-day discharge after a cholecystectomy is a common practice in the adult population and has been demonstrated as safe and viable for children as well. However, there is a lack of comprehensive teaching models for pediatric cholecystectomy. Drawing inspiration from standardized outpatient procedures, this study aimed to assess the clinical outcomes and feasibility of teaching programs and an Enhanced Recovery After Surgery (ERAS) protocol following ambulatory laparoscopic cholecystectomy in pediatric patients. In 2015, an ERAS pathway for laparoscopic cholecystectomy (LC) was implemented, focusing on admission procedures, surgery timing, anesthetic choices, analgesia, postoperative feeding, mobilization, and pain assessment. Day-case surgery was not applicable for acute cholecystitis, choledochal lithiasis, sickle cell disease, and hereditary spherocytosis cases. The protocol was employed for a group of attending surgeons and fellows, as well as a group of residents under the supervision of experienced surgeons. A retrospective analysis was conducted to evaluate the feasibility and effectiveness of ambulatory cholecystectomy in children and its utilization in training pediatric surgical trainees. Between 2015 and 2020, a total of 33 patients were included from a cohort of 162 children who underwent LC, with 15 children operated on by senior surgeons and 18 by young surgeons. The primary diagnoses were symptomatic gallbladder lithiasis (n = 32) and biliary dyskinesia (n = 1). The median age at the time of surgery was 11.3 years (interquartile range (IQR) 4.9-18), and the median duration of surgery was 54 min (IQR 13-145). One intraoperative complication occurred, involving gallbladder rupture and the dissemination of lithiasis into the peritoneal cavity. Three patients (9%) required an overnight stay, while no postoperative complications or readmissions within 30 days were observed. ERAS was successfully implemented in 30 patients (91%). No significant differences in surgical outcomes were noted between senior and young surgeons. At an average follow-up of 55 months, no long-term sequelae were identified. These findings align with the current trend of increasing use of outpatient laparoscopic cholecystectomy and underscore its feasibility in the pediatric population. The application of a structured ERAS protocol appears viable and practical for training the next generation of pediatric surgeons. Level III.

HPB P07 HIDA scan utilisation and its influence on the management of patients with Gallbladder Dysmotility Disorders – A Retrospective Multicentre Cohort Study

Abstract Background Hepatobiliary Iminodiacetic Acid (HIDA) - Cholecystokinin (CCK) and fatty meal scan is widely used in the investigation of patients with acalculour biliary-like pain as they present a significant diagnostic and management challenge to the healthcare system. This scan detects functional capacity of gallbladder in the form of gallbladder ejection fraction (GBEF). GBEF of &amp;lt;35% is consistent with biliary dyskinesia and &amp;gt;80% with hyperkinesia, a recently postulated pathology. Laparoscopic cholecystectomy (LC) remains the treatment of choice of for both the entities. We performed audit of utility of HIDA scan and interpretation of its results across three sites. Methods A retrospective cohort study of patents undergoing HIDA scan across three hospitals between January 2015 and December 2022. Patients with biliary pain according to ROME IV criteria of functional GI disorders were included. Electronic case notes were reviewed and demographics, laboratory results of bilirubin and ALP, radiological investigations, endoscopy result and HIDA scan result. Results A total of 225 patients underwent HIDA scan; median age was 42 years (IQR 34-53) and 194 (86.2%) were female. Median time form the onset of symptoms to HIDA scan was 19 months (IQR 6-24). 35 (15.5%) had GBEF &amp;lt;35%, 157 (69.7%) with GBEF 36-79%, and 33 (14.6 %) had GBEF ≥80. 36 patients had LC after HIDA scan: 19 (52.7%) for biliary dyskinesia, 12 (33.3%) for microlithiasis and/or biliary sludge on EUS and 5 (13.8%) had it for symptoms but normal GBEF. Histopathology of 4 patients had normal gallbladder, while 27 had chronic cholecystitis and/or cholesterosis. Conclusions HIDA scan is vital investigation for recurrent biliary-like pain without presence of gallstones and gallbladder dysmotility is not uncommon in this group of patients. HIDA scan should be more liberally utilised to rule out gallbladder dysmotility. Reporting method of HIDA scan should also be standardised to help interpret the results accurately.

HPB P55 An audit of the quality standards for Laparoscopic Cholecystectomy. Compliance with the AUGIS standards (AUGIS: Association of Upper Gastrointestinal Surgery of Great Britain and Ireland)

Abstract Background Laparoscopic cholecystectomy, which is a minimally invasive operation, is one of the most common surgical procedures in the UK and worldwide. Indications for LC include acute or chronic cholecystitis, symptomatic cholelithiasis, biliary dyskinesia, acalculous cholecystitis, gallstone pancreatitis, and gallbladder masses or polyps. The purpose of this audit was to assess and compare the outcomes after LC with the standards published by the association of upper GI surgeons (AUGIS) and to formulate measures to improve services at Royal Albert Edward Infirmary. Methods A data of 56 patients who underwent cholecystectomy was analysed retrospectively by two different auditors. All patients who underwent both open and laparoscopic cholecystectomies were included in this study. Results Our results showed that the majority of the patients (40/56) were females. Only 3 patients had open cholecystectomy while the rest of the 53 patients had LC. 67% (38/56) were done as a day case and discharged home the same day after surgery. None of the patients had an emergency and thus timely management of the disease in terms of surgery within the first 7 days of presentation. 7/56 patients were readmitted with different complications. No bile duct injuries were recorded. Conclusions Our hospital was found out to be compliant with only ⅙ criteria assessed. This study concludes that there is a need to improve outcomes in all domains especially the easily reversible factors such as day case rates and readmission due to complications.

OGBN P32 Outcomes of patient with Biliary Dyskinesia undergoing laparoscopic cholecystectomy - A multicentre cohort study

Abstract Background Biliary dyskinesia (BD) is a benign disorder characterized by recurrent episodes of biliary pain in the absence of gallstones on ultrasound, normal liver function tests and an ejection fraction (EF) of &amp;lt;35% on hepatobiliary iminodiacetic acid (HIDA) scan. Laparoscopic cholecystectomy (LC) remains the only known effective treatment for BD. However, many surgeons are reluctant to offer LC in such patients due to the fear of non-resolution of symptoms. Our aim was to analyse the outcome of patients who underwent LC for BD in terms of resolution of the biliary symptoms. Methods Multicentre retrospective cohort study of patients who have BD proven on HIDA scan from January 2015 to December 2022. BD was defined as EF ≤35% on HIDA scan. Those with EF ≤35% but had evidence of gallstones, microlithiasis or post op leak were excluded from the study. Electronic case notes were reviewed for demographic details, duration of symptoms, body mass index (BMI), liver function test (LFT), radiological investigations, endoscopy report and histopathology results of cholecystectomy. Rome IV criteria of functional gastrointestinal (GI) disorders was used to confirm symptoms were biliary in origin. Results Of the 222 patients who had HIDA scan, 35 (15.7%) patients had BD. 26 (74.2%) were female and median age was 42 years (IQR 33-55). Median time from the onset of symptoms and HIDA scan was 18 months. 19 (54.2%) patients had LC preformed, 9 (25.7%) were discharged with decision of LC not required, 4 (11.4 %) had no further review and 2 (5.7%) still having LC under consideration. Histopathology of LC was, chronic inflammation in 10 (52.6%), cholesterosis in 3 (15.8%) and 4 (20.1%) had normal gallbladder. 13 (68.4%) patients who underwent LC were symptom free 12 months post-surgery. Conclusions BD although painful and potentially lifestyle limiting, does not progress to more serious consequences if untreated. Diagnosis is usually difficult, and patients go through extensive investigations before they have HIDA scan. LC improves the symptoms in two thirds of patients and should be offered to all patients with BD with appropriate counselling.

COMPARATIVE CLINICAL CHARACTERISTICS OF HEALTH STATUS IN CHILDREN RESIDING IN ENVIRONMENTALLY POLLUTED AREA EXPOSED TO CHEMICAL FACTORS

Introduction. Prolonged residence of children in polluted environments significantly impairs their health, primarily due to the presence of chemical reagents (sulphur compounds). These chemical reagents induce nonspecific, polysystemic syndromes that affect the gastrointestinal, urinary, and immune systems, thus warranting the formation of risk groups to facilitate individual assessment, prevention, and treatment. This study aims at investigating the health status of children residing in an area affected by environmental contamination from sulphur chemicals. Material and Methods. The study employed general clinical analyses, ultrasound scanning, and medical and statistical analysis to examine 88 children. The sample included 56 children residing in an environment that is highly polluted with sulphur compounds and 32 children in a control group living in a conditionally clean environment. The participants were assessed by medical specialists including paediatricians, gastroenterologists, nephrologists, neurologists, ophthalmologists, immunologists, pulmonologists and dentists. Objective medical examinations were conducted using instrumental methods, including ultrasound diagnostics of internal organs and the thyroid gland, as well as echocardiography and densitometry. The statistical processing of the findings obtained was carried out by using the "Statistica 5.0" application program package and the standard statistical analysis (Excel 2010). The reliability in the examined groups of children was calculated according to the Student's criterion and was considered significant at p&lt;0.01.&#x0D; Results. Assessment of the clinical health status of 88 children was performed based on their primary medical records (form 112-o), complaints, medical history, diseases, age parameters, and laboratory indicators. The main group demonstrated statistically significant changes with a probability of p&lt;0.01. Children aged 13 to 16 years were more prevalent in the first group (30.4% versus 15.6%) and experienced significantly higher complaint frequency (p&lt;0.01) than the control group. This suggests non-specific manifestations of general intoxication and environmental maladaptation in children. Several detrimental factors were found to reduce the overall response of the children's bodies within the main group (р&lt;0.01), which serve as a premorbid background. These factors include the frequency of ante- and postnatal conditions such as preeclampsia during the first and second half of pregnancy, early artificial feeding, frequent acute respiratory distress syndrome (ARDS) and atopic history of dermatitis. A spectrum of sickness was discovered during the analysis of the clinical health state of the main group with a probability of p&lt;0.01. This includes chronic ailments of the gastroduodenal region (64.2% as opposed to 37.5%), biliary tract dyskinesia (32.1% - 18, 8%), dysmetabolic nephropathy (46.4% compared to 25.0%) and vegetative-vascular dystonia (46.4% and 15.6%). These findings indicate a decline in the body's immunological reactivity. Conclusions. The study reveals a significant decrease in the health status of children residing in an ecologically polluted environment with chemical sulfur compounds, compared to those dwelling in a clean environment (p&lt;0.01). Chronic conditions affecting the gastroduodenal region, dysmetabolic nephropathy, vegetative-vascular dystonia, recurrent colds, chronic tonsillitis, and dental caries were detected in the main study group. These conditions significantly (p&lt;0.01) imply the development of ecopathological syndromes, the creation of at-risk groups, and the need for preventive methods. Technical abbreviations will be explained when first used. Identified alterations in the clinical status of the assessed children with xenobiotic intoxication syndromes necessitate the establishment of at-risk groups, the pre-emptive avoidance and management of detected ecopathology.