Introduction:
Biliary dyskinesia is typically defined as a gallbladder ejection fraction (EF) <35% on hepatobiliary
iminodiacetic acid scan with
cholecystokinin stimulation (CCK-
HIDA) testing.
Cholecystectomy often leads to resolution of associated biliary
colic symptoms. Alternatively, there is a subset of symptomatic patients with normal gallbladder EF on CCK-
HIDA. It has been proposed that
pain with CCK injection is more predictive of symptom resolution after
cholecystectomy than low gallbladder EF. We reviewed our experience with pediatric patients with positive CCK provocation testing and a normal gallbladder EF in the absence of
gallstones. Materials and Methods: We retrospectively reviewed the records of all pediatric patients with normal hepatobiliary
iminodiacetic acid EFs (35%-80%) and
pain with CCK injection at a tertiary care center between 2016 and 2020. Age, gender, body mass index (BMI), CCK-
HIDA results, and pathology analysis were noted. Short- and long-term resolution of symptoms was determined by patient self-reporting at a mean of 3 weeks and 46 months, respectively. Results: Seventeen patients met inclusion criteria. Average age was 15.1 years (range, 12-17 years) with median BMI 24.9 (± 4.9 kg/m2). Mean CCK-
HIDA EF was 56.3% (± 11.4%). In total, 62.5% of patients had evidence of chronic
cholecystitis and/or cholesterolosis on pathology analysis. Of patients available for short-term and long-term postoperative follow-up, 80% and 83% reported complete or near complete resolution of symptoms, respectively. Conclusions: Normokinetic
biliary dyskinesia is poorly understood but appears to be associated with chronic
inflammation and cured by surgical intervention.
Laparoscopic cholecystectomy results in resolution of symptoms for a majority of patients and should be considered in those with
pain with CCK injection despite normal imaging studies. Clinical Trial Registration Number: 1657640-2.