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Patients with upper abdominal pain, nausea, and vomiting are often evaluated with ultrasound to diagnose symptomatic cholelithiasis or cholecystitis. With a normal ultrasound, a hepatobiliary iminodiacetic acid (HIDA) scan with ejection fraction (EF) is recommended to evaluate gallbladder function. The purpose of this study was to evaluate whether the HIDA scan with EF was appropriately utilized in considering cholecystectomy. Over 18 months, we performed 1533 HIDA scans with EF. After exclusion, 1501 were analyzable, 438 of whom underwent laparoscopic cholecystectomy. Patients were divided into two groups: those with typical and atypical symptoms of biliary colic. Our primary endpoint was symptom resolution of those who underwent laparoscopic cholecystectomy. Symptom resolution was assessed by chart review of postop visits or readmissions. In patients with typical symptoms, resolution occurred in 66 per cent of patients with positive HIDA and 77 per cent with negative HIDA (P = 0.292). In patients with atypical symptoms, resolution occurred in 64 per cent of patients with positive HIDA and 43 per cent with negative HIDA (P = 0.013). A HIDA scan with EF was not useful in patients with typical symptoms of biliary colic and negative ultrasounds, and should not be used to make a decision for cholecystectomy. However, this test can be helpful in patients with atypical symptoms, as it does predict symptom improvement in this group.
BILIARY DYSKINESIA (BD) IS A FUNCTIONAL disorder of the gallbladder. This term can encompass sphincter of Oddi dysfunction, but it is most often used to describe gallbladder dysfunction. Most patients suspected to have BD present with upper right quadrant pain and nausea and/or vomiting. Because the introduction of the less invasive laparoscopic cholecystectomy (LC), surgical management of patients with BD has increased.1 However, the diagnostic criteria used to determine when a patient has BD and should undergo a cholecystectomy remain controversial as the pathophysiology is poorly understood. The ROME foundation is a not-for-profit organization to promote awareness and to standardize management of functional gastrointestinal disorders, including the management of functional biliary pain. The ROME III diagnostic criteria for functional gallbladder disorder are shown in Table 1.2 Updated from the ROME II criteria, ROME III is based on clinical diagnosis and does not refer hepatobiliary iminodiacetic acid (HIDA) scan results. However, the ROME III...