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Normokinetic biliary dyskinesia: a novel diagnosis

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Abstract

Background

Biliary dyskinesia diagnosed with CCK-HIDA scan and ejection fraction less than 35 % has been successfully treated by laparoscopic cholecystectomy. However, a population of patients with symptomatic biliary pain and a normal CCK-HIDA scan never receive a diagnosis, and thus no definitive treatment. Some of these patients report a reproducible pain during their CCK-HIDA scan. It is hypothesized that these patients have a novel diagnosis, normokinetic biliary dyskinesia, and may have resolution of pain when treated with cholecystectomy.

Methods

A retrospective chart review was completed looking for patients with biliary pain in accordance with the ROME III criteria. Additional inclusion criteria were (1) greater than age 18 years, (2) reproducible biliary symptoms during the CCK-HIDA scan, and (3) an ejection fraction greater than 35 %. Treatment modality was laparoscopic cholecystectomy. Descriptive statistics were preformed, and data were reported as mean ± standard deviation and range.

Results

Nineteen patients met the inclusion criteria for this study from August 2008 to July 2011. There were 15 women and 4 men with a mean age of 48.4 ± 13.0 years. The mean ejection fraction was 75.1 ± 19.4 %. The average duration of preoperative symptoms was 6.8 ± 5.9 months and postoperative follow-up was 21.8 ± 10.6 months. Seventeen patients had complete resolution of symptoms, one had partial resolution, and one had no change. There was a complete resolution rate of 89.5 % and an improvement rate of 94.7 %.

Conclusions

We suggest that patients who present with biliary pain, a normal CCK-HIDA scan with an ejection fraction greater than 35 %, and with reproducible symptoms on infusion of CCK could have a novel diagnosis: normokinetic biliary dyskinesia. Currently, these patients are excluded from the diagnosis of biliary dyskinesia and thus treatment. We hypothesize a potential new diagnosis, suggest cholecystectomy as treatment, and recommend a prospective study design for further evaluation.

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Acknowledgments

The authors are indebted to the staff at the Center for Digestive & Metabolic Surgery, along with Stephanie Harris and Aidy Silva-Ortiz of Orlando Health Library for all their work in data and research collection.

Disclosures

Drs. Christopher DuCoin, Robert Faber, Marlon Ilagan, William Ruderman, and Daryl Wier have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery and Center for Digestive & Metabolic Surgery, Orlando Health, 77 West Underwood Street, 4th Floor Suite A, Orlando, FL, 32806, USA

    Christopher DuCoin, Robert Faber, Marlon Ilagan, William Ruderman & Daryl Wier

  2. Department of Internal Medicine, and Center for Digestive Health, Orlando Health, 77 West Underwood Street, 4th Floor Suite A, Orlando, FL, 32806, USA

    Christopher DuCoin, Robert Faber, Marlon Ilagan, William Ruderman & Daryl Wier

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  1. Christopher DuCoin
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Correspondence to Christopher DuCoin.

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DuCoin, C., Faber, R., Ilagan, M. et al. Normokinetic biliary dyskinesia: a novel diagnosis. Surg Endosc 26, 3088–3093 (2012). https://doi.org/10.1007/s00464-012-2342-0

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