title: Cholecystectomy alleviates acalculous biliary pain in patients with a reduced gallbladder ejection fraction.
abstract: BACKGROUND
  We sought to determine whether a reduced gallbladder ejection fraction, (GBEF) ascertained by cholecystokinin-cholescintigraphy (CCK-CS), predicts symptomatic improvement after cholecystectomy.
  
  
  METHODS
  Medical records of patients who had had CCK-CS as well as negative results of gallbladder ultrasonography were reviewed, and patients were contacted by telephone to determine whether they had benefited from cholecystectomy.
  
  
  RESULTS
  There were 35 patients (33 female, 2 male) who had a decreased GBEF. Cholecystectomy was done in 30, of whom 20 (67%) had resolution of pain, 8 (27%) had partial improvement, and 2 (7%) had no change. The 5 who declined cholecystectomy included none (0%) who were pain free, 2 (40%) who had partial improvement, and 3 (60%) who had no change. The clinical outcome of the two groups was significantly different. There were 14 patients (10 female, 4 male) with a normal GBEF. The 2 patients who had cholecystectomy were asymptomatic. Of the 12 patients who did not have cholecystectomy, 9 (75%) were asymptomatic, 1 (8%) had some improvement, and 2 (17%) had no change.
  
  
  CONCLUSIONS
  Cholecystectomy is indicated for patients with acalculous biliary pain and reduced GBEF, since symptoms will likely resolve with surgery and will persist without it. Cholecystectomy for patients with a normal GBEF should be considered only after failure of a nonoperative trial, since improvement usually occurs over time.
authors.affiliation: Division of Gastroenterology, University of Missouri Hospital and Clinics, Columbia, USA.
authors.forename: R
authors.initials: R
authors.lastname: Khosla
authors.forename: A
authors.initials: A
authors.lastname: Singh
authors.forename: B W
authors.initials: BW
authors.lastname: Miedema
authors.forename: J B
authors.initials: JB
authors.lastname: Marshall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002763:Cholecystectomy; D002764:Cholecystitis / Q000601:surgery; D002766:Cholecystokinin / Q000378:metabolism; D002908:Chronic Disease; D003085:Colic / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000378:metabolism; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016473:Gallbladder Emptying / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012074:Remission Induction; D012189:Retrospective Studies; D019785:Technetium Tc 99m Disofenin; D013689:Telephone; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D002766:Cholecystokinin; D019785:Technetium Tc 99m Disofenin