Kartik Akash, Jorge Irving A, Webb Christopher, Lim Elisabeth S, Chang Yu-Hui, Madura James
From the Department of Surgery, Tulane University, New Orleans, LA (Kartik).
Departments of Surgery (Jorge, Webb, Madura), Mayo Clinic, Phoenix, AZ.
J Am Coll Surg. 2023 Nov 1;237(5):706-710. doi: 10.1097/XCS.0000000000000793. Epub 2023 Jun 27.
Functional gallbladder disorder is most commonly defined by biliary colic and low ejection fraction (EF) on cholescintigraphy. Biliary hyperkinesia is a controversial type of functional gallbladder disorder, and its definition and the role of cholecystectomy in treating functional gallbladder disorder remains unclear.
We conducted a retrospective review of patients who underwent cholecystokinin-stimulated cholescintigraphy and cholecystectomy at 3 Mayo Clinic sites between 2007 and 2020. Eligible patients were 18 years or older, presented with symptoms of biliary disease, had an EF greater than 50%, underwent cholecystectomy, and had no evidence of acute cholecystitis or cholelithiasis on imaging. We used receiver operating characteristics curve analysis to identify the optimal cutoff value that predicted symptom resolution within 30 days of cholecystectomy.
A total of 2,929 cholecystokinin-stimulated cholescintigraphy scans were performed during the study period; the average EF was 67.5% and the median EF was 77%. Analyzing those with EFs greater than or equal to 50% yielded 1,596 patients with 141 (8.8%) going on to have cholecystectomy. No significant differences were found in age, sex, BMI, final pathology between patients with and without pain resolution. Using a cutoff EF of 81% was significantly associated with pain resolution after cholecystectomy (78.2% for EF greater than or equal to 81% vs 60.0% for EF less than 81%, p = 0.03). Chronic cholecystitis was found in 61.7% of the patients on final pathology.
We determined that an EF cutoff of 81% is a reasonable upper limit of normal gallbladder EF. Patients with biliary symptoms and an EF greater than 81% but no evidence of biliary disease on ultrasound or scintigraphy can be classified as having biliary hyperkinesia. Based on our findings, we recommend cholecystectomy for this patient population.
功能性胆囊疾病最常见的定义是胆绞痛和胆囊闪烁扫描时低射血分数（EF）。胆囊运动亢进是一种有争议的功能性胆囊疾病类型，其定义以及胆囊切除术在治疗功能性胆囊疾病中的作用仍不明确。
我们对2007年至2020年期间在梅奥诊所3个地点接受胆囊收缩素刺激胆囊闪烁扫描和胆囊切除术的患者进行了回顾性研究。符合条件的患者年龄在18岁及以上，有胆道疾病症状，EF大于50%，接受了胆囊切除术，且影像学检查无急性胆囊炎或胆结石证据。我们使用受试者工作特征曲线分析来确定预测胆囊切除术后30天内症状缓解的最佳临界值。
在研究期间共进行了2929次胆囊收缩素刺激胆囊闪烁扫描；平均EF为67.5%，中位数EF为77%。对EF大于或等于50%的患者进行分析，得到1596例患者，其中141例（8.8%）接受了胆囊切除术。疼痛缓解和未缓解的患者在年龄、性别、BMI、最终病理方面未发现显著差异。使用81%的临界EF与胆囊切除术后疼痛缓解显著相关（EF大于或等于81%的患者为78.2%，EF小于81%的患者为60.0%，p = 0.03）。最终病理显示61.7%的患者有慢性胆囊炎。
我们确定81%的EF临界值是正常胆囊EF的合理上限。有胆道症状且EF大于81%但超声或闪烁扫描无胆道疾病证据的患者可归类为胆囊运动亢进。基于我们的研究结果，我们建议对这一患者群体进行胆囊切除术。
