General Surgery Trainee, Health Education North East, Newcastle upon Tyne, UK.
General Surgery Trainee, North West, Manchester University NHS Foundation Trust, Manchester, UK.
Clin J Gastroenterol. 2021 Oct;14(5):1308-1317. doi: 10.1007/s12328-021-01463-x. Epub 2021 Jun 11.
Biliary hyperkinesia is typically diagnosed in patients with biliary-like pain and no evidence of gall stones on imaging modalities but who have had biliary scintigraphy scan (HIDA) that shows ejection fraction ≥ 80%. This study aims to identify whether the removal of the gall bladder can alleviate the symptoms associated with biliary hyperkinesia. Systematic search following PRISMA guidelines was done from inception to January 2020 using PubMed/Medline, OVID, Embase, Cochrane database of systemic reviews, Cochrane central register of controlled trials, The Database of Abstracts of Reviews of Effects (DARE) and Cochrane library databases. Results were expressed as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) or standardized MD (SMD) for continuous outcomes. A meta-analysis was done using random-effect model in RevMan 5.4 software. Thirteen studies met the inclusion criteria and were included in the review. A total of 332 patients diagnosed with biliary hyperkinesia underwent cholecystectomy, of whom 303 (91.3%) reported symptomatic improvement RR 8.67 (95% CI 4.95, 15.16) P = 0.01. Six studies described abnormal histological features in 163/181 (90.05%) with high GB EF. RR 7.88 (95% CI 3.94, 15.75) P = 0.08. Chronic cholecystitis n = 155 (95%), cholesterolosis n = 7 (4.3%), and one showed features of acute cholecystitis. Patients with typical biliary colic symptoms without gallstones and markedly high ejection fraction might benefit from having cholecystectomy to alleviate their symptoms.
胆系运动过度症通常被诊断为有胆绞痛样疼痛且影像学检查未见胆结石但行胆闪烁扫描（HIDA）显示射血分数≥80%的患者。本研究旨在确定是否切除胆囊可以缓解与胆系运动过度症相关的症状。系统检索从建库至 2020 年 1 月，使用了 PubMed/Medline、OVID、Embase、Cochrane 系统评价数据库、Cochrane 对照试验中心注册库、疗效评价文摘数据库（DARE）和 Cochrane 图书馆数据库。结果以二分类结局的风险比（RR）和 95%置信区间（CI）或连续性结局的均数差（MD）或标准化均数差（SMD）表示。使用 RevMan 5.4 软件进行随机效应模型的荟萃分析。13 项研究符合纳入标准并被纳入综述。共有 332 例诊断为胆系运动过度症的患者接受了胆囊切除术，其中 303 例（91.3%）报告症状改善 RR 8.67（95% CI 4.95，15.16）P=0.01。6 项研究描述了 163/181 例（90.05%）高胆囊 EF 患者的异常组织学特征。RR 7.88（95% CI 3.94，15.75）P=0.08。慢性胆囊炎 n=155（95%）、胆固醇沉着症 n=7（4.3%）和 1 例有急性胆囊炎特征。有典型胆绞痛样症状且胆囊射血分数显著增高而无胆结石的患者可能受益于胆囊切除术来缓解症状。
