title: Management of gallbladder dyskinesia: patient outcomes following positive ⁹⁹mtechnetium (Tc)-labelled hepatic iminodiacetic acid (HIDA) scintigraphy with cholecystokinin (CCK) provocation and laparoscopic cholecystectomy.
abstract: OBJECTIVE
  To evaluate clinical outcomes in patients with typical biliary pain, normal ultrasonic findings, and a positive (99m)technetium (Tc)-labelled hepatic iminodiacetic acid analogue (HIDA) scintigraphy with cholecystokinin (CCK) provocation indicating gallbladder dyskinesia, as per Rome III criteria, undergoing laparoscopic cholecystectomy (LC).
  
  
  METHODS
  Consecutive patients undergoing LC for gallbladder dyskinesia were identified retrospectively. They were followed up by telephone interview and review of the electronic case records to assess symptom resolution.
  
  
  RESULTS
  One hundred consecutive patients (median age 44; 80% female) with abnormal gallbladder ejection fraction (GB-EF <35%) were followed up for a median of 12 months (range 2-80 months). Following LC, 84% reported symptomatic improvement and 52% had no residual pain. Twelve percent had persisting preoperative-type pain of either unchanged or worsening severity. Neither pathological features of chronic cholecystitis (87% of 92 incidences when histology available) nor reproduction of pain on CCK injection were significantly predictive of symptom outcome or pain relief post-LC.
  
  
  CONCLUSIONS
  In one of the largest outcome series of gallbladder dyskinesia patients in the UK with a positive provocation HIDA scintigraphy examination and LC, the present study shows that the test is a useful functional diagnostic tool in the management of patients with typical biliary pain and normal ultrasound, with favourable outcomes following surgery.
authors.affiliation: Department of Transplant and HPB Surgery, St James University Hospital, Leeds, UK.
authors.forename: R V
authors.initials: RV
authors.lastname: Dave
authors.affiliation: Department of Transplant and HPB Surgery, St James University Hospital, Leeds, UK.
authors.forename: S
authors.initials: S
authors.lastname: Pathak
authors.affiliation: Department of Transplant and HPB Surgery, St James University Hospital, Leeds, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Cockbain
authors.affiliation: Department of Transplant and HPB Surgery, St James University Hospital, Leeds, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Lodge
authors.affiliation: Department of Transplant and HPB Surgery, St James University Hospital, Leeds, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Smith
authors.affiliation: Department of Clinical Radiology, St James University Hospital, Leeds, UK; Department of Nuclear Medicine, St James University Hospital, Leeds, UK. Electronic address: Fahmid.Chowdhury@nhs.net.
authors.forename: F U
authors.initials: FU
authors.lastname: Chowdhury
authors.affiliation: Department of Transplant and HPB Surgery, St James University Hospital, Leeds, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001657:Biliary Dyskinesia / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002766:Cholecystokinin / Q000378:metabolism; D005260:Female; D006801:Humans; D007098:Imino Acids; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013667:Technetium; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007098:Imino Acids; D013667:Technetium; D002766:Cholecystokinin; C008109:iminodiacetic acid