title: Cholecystectomy for biliary dyskinesia: how did we get there?
abstract: BACKGROUND
  The focus of biliary dyskinesia (BD) shifted within the last 30 years, moving from symptoms after cholecystectomy (CCY) to symptoms with morphological normal gallbladder, but low gallbladder ejection fraction.
  
  
  METHODS
  We searched the pubmed database to systematically review studies focusing on the diagnosis and treatment of gallbladder dysfunction.
  
  
  RESULTS
  Impaired gallbladder contraction can be found in about 20% of healthy controls and an even higher number of patients with various other disorders. Surgery for BD increased after introduction of laparoscopic CCY, with BD now accounting for >20% of CCY in adults and up to 60% in pediatric patients. The majority of cases reported were operated in the USA, which differs from surgical series for cholelithiasis. Postoperative outcomes do not differ between groups with abnormal or normal gallbladder function.
  
  
  CONCLUSIONS
  Functional gallbladder testing should not be seen as an indicator of relevant biliary tract disease or prognostic marker to identify patients who may benefit from operative intervention. Instead biliary dyskinesia should be considered as a part of a spectrum of functional disorders, which are generally managed conservatively. Small proof of concept studies have demonstrated effects of medical therapy on biliary dysfunction and should thus be never tested in appropriately designed trials.
authors.affiliation: Divisions of Gastroenterology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA, 15213, USA, bielefeldtk@upmc.edu.
authors.forename: Klaus
authors.initials: K
authors.lastname: Bielefeldt
authors.forename: Shreyas
authors.initials: S
authors.lastname: Saligram
authors.forename: Susan L
authors.initials: SL
authors.lastname: Zickmund
authors.forename: Anwar
authors.initials: A
authors.lastname: Dudekula
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Olyaee
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
mesh_terms: D001657:Biliary Dyskinesia / Q000175:diagnosis* / Q000601:surgery*; D002763:Cholecystectomy; D005705:Gallbladder Diseases / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D013997:Time Factors