A common scenario that comes up in the GI forum that I moderate is the subject of acalculous biliary pain (ABP – gallbladder pain in the absence of gallstones). The NY Times has an interesting case of this today, where it was diagnosed by repeating the HIDA scan with CCK stimulation. It is a common recommendation that those with a low gallbladder ejection fraction benefit from a cholecystectomy:
In people with normal gallbladders, the ejection fraction ranges between 35-75 percent. Patients who suffer from bouts of biliary pain and have lower ejection fraction readings are assumed to have ABP. Studies have shown that surgical removal of the gallbladder (cholecystectomy) helps ABP patients more than 90 percent of the time.
However, there is some controversy surrounding this recommendation, as seen from this meta-analysis:
These data do not support the use of GBEF to select patients with suspected functional biliary pain for cholecystectomy. Prospective randomized trials are required if this practice is to be evidence-based.
Bottom-line: although cholecystectomy may have helped this particular case in the NY Times, prospective studies are needed before making this a definitive recommendation.
topics: gallbaldder, cholecystectomy
