Gallbladder Disorder Research Articles

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.

The value of HIDA scan in functional gallbladder disorder: a clinico-patho- radiological outcome study

The value of HIDA scan in functional gallbladder disorder: a clinico-patho- radiological outcome study

The value of HIDA scan for functional gallbladder disorder: a clinical pathoradiological correlation and outcome study

The value of HIDA scan for functional gallbladder disorder: a clinical pathoradiological correlation and outcome study

Функциональные расстройства желудочно- кишечного тракта у детей дошкольного возраста: современные подходы к терапии

Recurrent abdominal pain (RAP) syndrome is a common pathology of childhood, which is often encountered in pediatric outpatient practice. Currently, pharmacological options are insufficiently developed, in this regard, we decided to use the drug trimebutin in the form of powder for preparation of suspension for oral administration for the treatment of this group of patients. Objective. To evaluate the effect of trimebutine therapy in the form of powder for preparation of oral suspension on the course of pain syndrome and a number of associated symptoms in preschool patients with functional RAP syndrome. Patients and methods. The study included 84 children aged 3 to 5 years who applied to the consultative and diagnostic clinic "Gastroenterological Center" (Ufa, Republic of Bashkortostan). The diagnosis of functional gastrointestinal disorders (FGD) was established in 53 patients (63.1%) of the total number of patients aged 3 to 5 years with RAP. Results. Complete disappearance of symptoms occurred in 48 (90.5%) outpatients. Commitment to treatment was high in the majority of patients (73.6%, 39 children), which, among other things, ensured high efficacy of the therapy. Conclusion. Trimebutin in the form of powder for suspension preparation in our study showed excellent efficacy in the management of RAP syndrome and associated symptoms, which is extremely valuable for determining the tactics of therapy of this pathology in preschool children in pediatric practice. The drug was well tolerated by patients, which ensured high adherence to treatment. Key words: recurrent abdominal pain, functional gastrointestinal disorders, functional dyspepsia, irritable bowel syndrome, functional gallbladder disorder, sphincter of Oddi dysfunction, functional abdominal pain, trimebutin, Trimedate

Functional Gallbladder Disorder: Characteristic Hepatobiliary Scintigraphy Findings

Functional Gallbladder Disorder: Characteristic Hepatobiliary Scintigraphy Findings

The Results of Patients with Histopathological Diagnosed Xanthogranulomatous Cholecystitis, a Single-Center Experience

Objective: Xanthogranulomatous cholecystitis (XGC) is a rare and benign gallbladder disorder. Unnecessary or additional surgical interventions were reported secondary to extended inflammation or suspicion of malignancy. This study aimed to examine patients diagnosed with XGC in our clinic. Materials and Methods: The data of patients were recruited who underwent cholecystectomy and diagnosed with XGC. We excluded patients with no radiologic examination, accompanying pancreas, biliary tree, and hepatic cancer. We recruited the data of patients' demographics, clinical symptoms, imaging studies, characteristics of surgery, and postoperative outcomes. Results: The mean age was 57 ±19.1 years, and there were 12 (31%) females. Abdominal pain was found in 38 (97%) patients as a significant complaint. Elective and emergent cholecystectomy were performed in 18 (46%) and 21 (54%) patients, respectively. Open surgery was performed on 17 (44%) patients, and laparoscopic surgery on 22 (56%). The surgery was completed as laparoscopic in 17 (77%) patients. According to radiologic examinations, suspicious gallbladder malignancy was reported in 4 (10%), 8 (20%), and 4 (10%) patients with USG, CT, and MRI, respectively. There was 1 (3%) patient diagnosed with XGC by USG, 4 (10%) by CT, and 1 (3%) by MRI. Common bile duct (CBD) stone was observed in 10 (26%) of 39 patients. Conversion to open surgery was found in 5 (13%) patients. Intraoperative frozen section analysis was performed in 8 (20%) patients. Extended surgery was performed to 7 (17%) patients. Conclusion: Preoperative diagnosis and surgical management of XGC can be challenging. If a surgeon has suspicion of XGC in preoperative period, expert radiologist opinion should be asked, and they should always keep in mind to perform frozen-section examination.

Functional gallbladder disorder: Interim analysis of a prospective cohort study

BackgroundFunctional gallbladder disorder (FGBD) remains a controversial indication for cholecystectomy. MethodsA prospective cohort study enrolled patients strictly meeting Rome criteria for FGBD, and cholecystectomy was performed. They were assessed pre- and 3 and 6 months postoperatively with surveys of abdominal pain and quality of life (RAPID and SF-12 surveys, respectively). Interim analysis was performed. ResultsAlthough neither ejection fraction nor pain reproduction predicted success after cholecystectomy, the vast majority of enrolled patients had a successful outcome after undergoing cholecystectomy for FGBD: of a planned 100 patients, 46 were enrolled. Of 31 evaluable patients, 26 (83.9 ​%) reported RAPID improvement and 28 (93.3 ​%) SF12 improvement at 3- or 6-month follow-up. ConclusionFGBD, strictly diagnosed, should perhaps no longer be a controversial indication for cholecystectomy, since its success rate for biliary pain in this study was similar to that for symptomatic cholelithiasis. Larger-scale studies or randomized trials may confirm these findings.

Use of a Fatty Meal Cholecystagogue Protocol in Hepatobiliary Scintigraphy for Chronic Functional Gallbladder Disease.

Chronic functional gallbladder disorder, characterized by biliary pain in the absence of structural pathology, poses a diagnostic challenge necessitating reliable cholecystagogues for accurate evaluation. However, recurrent shortages of synthetic cholecystokinin analogs have prompted the exploration of alternative agents. This paper describes the efficacy of Ensure Plus as a viable fatty meal substitute for hepatobiliary scintigraphy in assessing chronic functional gallbladder disorder. Through comparative studies, Ensure Plus demonstrates comparable diagnostic accuracy to cholecystokinin in similar patient populations. Furthermore, Ensure Plus demonstrates significant symptom improvement after cholecystectomy in patients with anomalous gallbladder ejection fractions. This paper offers a detailed protocol for the seamless integration of Ensure Plus into hepatobiliary scintigraphy, providing clinicians with a valuable tool to navigate cholecystokinin shortages while maintaining diagnostic precision in cases of chronic functional gallbladder disorder. The use of Ensure Plus not only addresses practical supply challenges but also underscores its potential as a cost-effective and clinically sound alternative in biliary diagnostics.

A Biophysical Approach to Functional Gallbladder Disorder Leads to the Hypothesis That Salmonella Plays a Relevant Role in the Etiology of This Disease: A Retrospective Observational Pilot Study

A Biophysical Approach to Functional Gallbladder Disorder Leads to the Hypothesis That Salmonella Plays a Relevant Role in the Etiology of This Disease: A Retrospective Observational Pilot Study

Defining Biliary Hyperkinesia and the Role of Cholecystectomy.

Functional gallbladder disorder is most commonly defined by biliary colic and low ejection fraction (EF) on cholescintigraphy. Biliary hyperkinesia is a controversial type of functional gallbladder disorder, and its definition and the role of cholecystectomy in treating functional gallbladder disorder remains unclear. We conducted a retrospective review of patients who underwent cholecystokinin-stimulated cholescintigraphy and cholecystectomy at 3 Mayo Clinic sites between 2007 and 2020. Eligible patients were 18 years or older, presented with symptoms of biliary disease, had an EF greater than 50%, underwent cholecystectomy, and had no evidence of acute cholecystitis or cholelithiasis on imaging. We used receiver operating characteristics curve analysis to identify the optimal cutoff value that predicted symptom resolution within 30 days of cholecystectomy. A total of 2,929 cholecystokinin-stimulated cholescintigraphy scans were performed during the study period; the average EF was 67.5% and the median EF was 77%. Analyzing those with EFs greater than or equal to 50% yielded 1,596 patients with 141 (8.8%) going on to have cholecystectomy. No significant differences were found in age, sex, BMI, final pathology between patients with and without pain resolution. Using a cutoff EF of 81% was significantly associated with pain resolution after cholecystectomy (78.2% for EF greater than or equal to 81% vs 60.0% for EF less than 81%, p = 0.03). Chronic cholecystitis was found in 61.7% of the patients on final pathology. We determined that an EF cutoff of 81% is a reasonable upper limit of normal gallbladder EF. Patients with biliary symptoms and an EF greater than 81% but no evidence of biliary disease on ultrasound or scintigraphy can be classified as having biliary hyperkinesia. Based on our findings, we recommend cholecystectomy for this patient population.

Functional gallbladder disorder: Interim analysis of a prospective cohort study

Background: Functional gallbladder disorder (FGBD) is a controversial indication for cholecystectomy (CCY) in the United States, and is rarely done at all in Europe. The aim of the current study was to better characterize indications for FGBD.

The Role of Cholecystectomy in Hyperkinetic Gallbladder: A Retrospective Cohort Study in a Rural Hospital.

Background Biliary dyskinesia is a functional gallbladder disorder in which there is an absence of a structural or mechanical cause for biliary pain. A cholecystokinin-hepatobiliary iminodiacetic acid (CCK-HIDA) scan is typically performed during workup, and cholecystectomy is the accepted treatment for low ejection fraction (EF) (less than 33%, as defined by the literature). However, few studies have examined the role of cholecystectomy in hyperkinetic gallbladder (EF ≥80%). The aim of our study was to examine symptom resolution following minimally invasive cholecystectomy in patients with hyperkinetic gallbladder. Methodology A retrospective chart review was conducted at Robert Packer Hospital in Sayre, PA. Patients who underwent minimally invasive cholecystectomy for biliary colic with EF ≥80% and who were without cholelithiasis on preoperative imaging or on final pathology were included in this study. The main outcome was symptom resolution at the postoperative visit. Data collected included age, gender, EF, body mass index, symptoms with CCK infusion, and pathology. Results A total of 48 patients were included. The mean age of patients was 41.2 years (standard deviation = 14.4), and the median age of patients was 42.2 years, with a range of 17-71 years. The majority of patients were female (83.3%). Overall, 58.3% of patients had replication of symptoms with CCK infusion. The mean gallbladder EF was 87.3%, with a median of 87.0 and a range of 80-98. In total, 33 (68.8%) patients had chronic cholecystitis on final pathology reports. There was a 95.9% symptom resolution rate among our patients two weeks postoperatively. Conclusions The overwhelming majority of patients experienced symptom resolution prior to their two-week postoperative visit following minimally invasive cholecystectomy for hyperkinetic gallbladder. These results strongly suggest a role of surgical management in patients with high EF.

Acute Acalculous Cholecystitis in a Patient with Systemic Lupus Erythematous Case Report

Acute Acalculous Cholecystitis “AAC” is defined by inflammation of the gallbladder without the presence of gallstones. It is by far less common than acute calculous cholecystitis where it only counts 5-10% of all cases of acute cholecystitis. In a patient with the disease of systemic lupus erythematous (SLE) having a gallbladder disorder is not common. Herein, we present a 43-year- old lady who is known case of hypertension, SLE, and End-stage renal disease on hemodialysis due to lupus nephritis presented to the emergency department with a right upper abdominal pain, and abdominal ultrasound revealed acalcular cholecystitis. Further diagnostic tools supported the diagnosis, and she underwent after preparation uneventful laparoscopic cholecystectomy (LC).

Sincalide-Stimulated Cholescintigraphy: A Retrospective Study and Proposal of a Modified Workflow.

Current guidelines for sincalide-stimulated cholescintigraphy (SSC) call for a 60-minute sincalide infusion, and a gallbladder ejection fraction (GBEF) ≥38% is considered normal. In this retrospective study, we hypothesize that most patients reach a normal GBEF by 30 minutes. Eligible patients had undergone a 60-minute SSC from January to December 2019. The clinical SSC data were previously processed on a Xeleris workstation (GE Healthcare). In subjects with GBEF ≥38% based on standard SSC, the GBEF at 20 minutes and 30 minutes were retrospectively calculated using manual pixel height measurements. Receiving operating characteristic was analyzed to determine the best GBEF cutoff at 30 minutes. Of 302 subjects, mean age of 46 ± 17 years, 33 (10.9%) showed an abnormal GBEF <38% suggestive of functional gallbladder disorder. In the remaining 269 patients (89.1%) with a normal GBEF, 60.6% and 86.6% reached a normal GBEF at 20 minutes and 30 minutes, respectively. Moreover, a GBEF threshold >29.1% at 30 minutes was associated with a negative predictive value of 99.6%, indicating that a 60-minute SSC was not necessary. The GBEF values were not associated with sex, age, patient symptoms, or type of referral. Manually calculated GBEFs on the time-activity curve showed excellent correlation with the primary values. We propose a modified workflow that splits the 60-minute SSC into two 30-minute image sets to allow for a screening GBEF at 30 minutes. If GBEF is >29.1% at 30 minutes, the second image set may be stopped, and the examination is complete. The majority of patients (77.2%) undergoing the standard 60-minute SSC reach a normal GBEF already by 30 minutes. The proposed workflow shortens the SCC procedure by 30 minutes, while maintaining high diagnostic accuracy and contributing to improved procedure efficiency and reduced patient discomfort as well as symptoms.

Incidence of acute cholecystitis underwent cholecystectomy in incidence dialysis patients: a nationwide population-based cohort study in Korea.

BackgroundPatients on dialysis have numerous gastrointestinal problems related to uremia, which may represent concealed cholecystitis. We investigated the incidence and risk of acute cholecystitis in dialysis patients and used national health insurance data to identify acute cholecystitis in Korea.MethodsThe Korean National Health Insurance Database was used, with excerpted data from the insurance claim of the International Classification of Diseases code of dialysis and acute cholecystitis treated with cholecystectomy. We included all patients who commenced dialysis between 2004 and 2013 and selected the same number of controls via propensity score matching.ResultsA total of 59,999 dialysis and control patients were analyzed; of these, 3,940 dialysis patients (6.6%) and 647 controls (1.1%) developed acute cholecystitis. The overall incidence of acute cholecystitis was 8.04-fold higher in dialysis patients than in controls (95% confidence interval, 7.40–8.76). The acute cholecystitis incidence rate (incidence rate ratio, 23.13) was especially high in the oldest group of dialysis patients (aged ≥80 years) compared with that of controls. Dialysis was a significant risk factor for acute cholecystitis (adjusted hazard ratio, 8.94; 95% confidence interval, 8.19–9.76). Acute cholecystitis developed in 3,558 of 54,103 hemodialysis patients (6.6%) and in 382 of 5,896 patients (6.5%) undergoing peritoneal dialysis.ConclusionsPatients undergoing dialysis had a higher incidence and risk of acute cholecystitis than the general population. The possibility of a gallbladder disorder developing in patients with gastrointestinal problems should be considered in the dialysis clinic.

Clinical utility of stimulated cholescintigraphy using a standardized Ensure-Plus fatty meal protocol in patients with suspected functional gallbladder disorder: a retrospective study of seven-years clinical experience.

The clinical utility of fatty meal stimulated cholescintigraphy particularly using a standardized formulation in patients with suspected functional gallbladder disorder has not been extensively studied. We present our seven-year clinical experience using an Ensure plus protocol. A retrospective study was performed on patients undergoing stimulated cholescintigraphy using Ensure Plus for evaluation of suspected functional gallbladder disorder. A gallbladder ejection fraction (GBEF) of <33% was considered abnormal. Of the 173 patients evaluated, 57 (33%) had an abnormal GBEF, 112 (65%) had a normal GBEF and 4 (2%) had no gallbladder visualization. Of the 57 patients with an abnormal GBEF, symptom improvement occurred in 30/31 (97%) who underwent cholecystectomy and in 17/26 (65%) who were managed conservatively (p= 0.003). Of the 112 patients with a normal GBEF, symptom improvement occurred in 8/10 (80%) who underwent cholecystectomy and 74/102 (73%) who were managed conservatively (p= 1.000). In the subgroup of 102 patients with a normal GBEF managed conservatively, those without symptomatic improvement had lower GBEFs compared to those with symptomatic improvement (median GBEF 46% versus 57%, p= 0.019). Our retrospective results support a clinical role for stimulated cholescintigraphy using Ensure Plus in the evaluation of patients with suspected functional gallbladder disorder. While an abnormal GBEF predicts good surgical outcome, our results suggest that using an absolute GBEF cut off value of <33% may not apply to all patients and hence GBEF results should only be used as an adjunct in the surgical decision-making process.

S3576 Oddity of an Opiated Oddi: A Case of Sphincter of Oddi Dysfunction

Introduction: We present a case of recurrent right upper quadrant (RUQ) pain resulting from Sphincter of Oddi Dysfunction (SOD) in the setting of chronic opioid use. SOD is a functional gastrointestinal disorder that presents similarly to other disorders of the biliary tree. Understanding features of this disorder and its etiologies can streamline evaluation and treatment. Case Description/Methods: Our patient is a 77-year-old male, chronic opioid user, who had multiple Emergency Department (ED) visits and hospital admissions for RUQ pain in the setting of significantly elevated liver associated enzymes (LAEs). However, repeated imaging of the RUQ with CT, Ultrasound, and MRCP remained largely unremarkable. On a subsequent presentation, the patient experienced severe increase in pain after administration of morphine. Lab investigation showed an abrupt increase in LAEs and lipase after administration of morphine. Imaging was obtained, and was again inconsistent with cholecystitis. Interestingly, he attained analgesia with meperidine on admission. During a following ED visit, RUQ imaging showed non-specific gallbladder inflammation, and a Hepatobiliary Iminodiacetic Acid (HIDA) scan showed low gallbladder ejection fraction (GBEF). These findings suggested Functional Gallbladder Disorder and laparoscopic cholecystectomy was performed. Unfortunately, ten days later the patient had worsening RUQ pain with no signs of obstruction. With diagnostic criteria for SOD met and other etiologies ruled out, our patient was referred for sphincterotomy. Discussion: Opiate-induced SOD is theoretically well known, but there have been only few reported cases in literature. Furthermore, SOD is difficult to diagnose, as providers must first rule out other hepatobiliary disease. ROME IV Diagnostic Criteria for Functional Gastrointestinal Disorders was used in review of our case. Biliary pain, absence of bile duct stones or other structural abnormalities, and elevated LAEs fulfilled the criteria for this disorder. This case highlights the clinical evaluation and care of SOD. While all opioids have been shown to contract the Sphincter of Oddi (SO), morphine has been shown to strongly cause this contraction, and is one of the earliest reported causes of SOD in literature. Meperidine has been shown to have minimal effect on the SO contraction and is the ideal opioid to treat pain of biliary or pancreatic source.

Therapeutic-resort rehabilitation of children with gallbladder pathology living in ecologically unfavorable territories of the Krasnodar Region

Objective: To study the eff ectiveness of medical and preventive schemes of spa rehabilitation of children with biliary tract diseases living in ecologically unfavorable areas of the Krasnodar region.Materials and Methods: The study was conducted among children aged 7 to 14 years old burdened with gallbladder pathology (dysfunctional disorders of the biliary tract (DRBT)). In 2017-2020, the eff ectiveness of the therapeutic-resort stage of rehabilitation was studied in 127 children. The children permanently resided in Krasnodar and were admitted to the therapeutic spa-resort center of mother and child “Diluch” in the resort city of Anapa. The authors selected 93 (73.2%) children with hypofunctional gallbladder disorder (GI) and 34 (26.8%) children with hyperfunctional GI disorder for spa treatment. The control group included children with the 1st group of health. The eff ectiveness of the applied methods of rehabilitation was evaluated based on laboratory and instrumental studies, as well as periodic dynamic medical examinations, which included the collection of complaints, physical examination, and palpation of the abdominal cavity.Results: Therapeutic spa-rehabilitation of children with DRBT included balneotherapy, physiotherapy, and aerophytotherapy without the use of pharmacological drugs. At the same time, there was an improvement in the condition of both children with DRBT of the hypertensive type (94.1%) and among the subjects with DRBT of the hypotonic type (90.1). There were no cases of the condition worsening in the observed children with DRBT that permanently resided in unfavorable conditions of the Krasnodar Region.Conclusions: Based on the obtained results, it can be suggested that diff erentiated comprehensive rehabilitation in the conditions of the balneological complex of the resort city of Anapa performed aft er the main treatment of gastrointestinal pathology is feasible for children and adolescents experiencing adverse environmental impacts at a permanent place of residence in the Krasnodar region.

Дисфункція біліарного тракту в дітей: традиційні підходи й нові постулати

Захворюваність органів травлення в дітей посідає одне з провідних місць у структурі соматичної патології дитячого віку. Функціональні розлади біліарного тракту являють собою комплекс клінічних симптомів, що розвинулись у результаті моторно-тонічних дисфункцій жовчного міхура, жовчних проток та сфінктерного апарату жовчних шляхів. Для написання огляду здійснювався пошук даних із використанням даних Scopus, Web of Science, MedLine, PubMed, Google Scholar, CyberLeninka, РІНЦ за такими ключовими словами: біліарна дисфункція, функціональний розлад жовчного міхура, функціональний розлад сфінктера Одді, біліарна дискінезія, діти. У статті розглядаються етіопатогенетичні аспекти біліарної патології в дитячому віці. Розглянуті сучасні діагностичні та терапевтичні підходи щодо розладів жовчного міхура та сфінктера Одді в педіатричних пацієнтів у розрізі Римських критеріїв функціональних гастроінтестинальних розладів IV перегляду.

Mast cell infiltration and activation in the gallbladder wall: Implications for the pathogenesis of functional gallbladder disorder in adult patients

BackgroundFunctional gallbladder disorder (FGD) is characterized by recurrent biliary colic with a decreased gallbladder ejection fraction on cholescintigraphy but absence of visible gallbladder abnormalities on ultrasonography. FGD is generally regarded as a primary gallbladder motility disturbance, however, the underlying pathophysiology remains largely unknown. In this study, we investigated the potential role of mast cells in the pathogenesis of FGD by examining mast cell density and activation in the gallbladder wall. DesignTwenty adult patients with FGD undergoing cholecystectomy were included in the study. Seven patients with no gallbladder disease were served as controls who were subject to incidental cholecystectomy during abdominal surgery such as partial hepatectomy. The density of mast cells in the gallbladder wall was assessed by immunohistochemistry and by toluidine blue special stain. Mast cell activation was evaluated by calculating the percentage of degranulated mast cells on toluidine blue stain. ResultsCompared to the controls, patients with FGD showed a significant increase in mast cell infiltration in the gallbladder walls. Peak mast cell accumulation was predominantly located in the inner muscular layer of the gallbladder wall. Mast cell activation was also markedly increased in the FGD group as evidenced by significantly enhanced mast cell degranulation. ConclusionsMast cell infiltration and activation were significantly increased in the muscular wall of gallbladders from FGD patients, suggesting potential involvement of mast cells in the compromised gallbladder motility in adult patients with FGD.