A retrospective cohort study to examine the association between the persistence of abdominal pain after cholecystectomy and ejection fraction on HIDA scan in patients with biliary dyskinesia

Background and aims

The persistence of pain in patients who underwent cholecystectomy primarily for biliary dyskinesia has been associated with gall bladder ejection fraction (GBEF) found on hepatobiliary iminodiacetic acid (HIDA) scan. Cholecystectomy is a definitive treatment for cholelithiasis but is questionable in biliary dyskinesia. During the postoperative follow-up, gastroenterologists and surgeons often found that some patients with biliary dyskinesia continue to experience biliary pain even after surgery. This study aims to investigate whether the value of GBEF found on the HIDA scan predicts the persistence of pain after cholecystectomy in patients with biliary dyskinesia (EF <35% on HIDA scan).

Methods

It is a retrospective cohort study conducted at Kern Medical by recruiting patients from November 2019 to October 2022 in consecutive manner. It is a single sample study consisting of post-cholecystectomy biliary dyskinesia patients with dichotomous outcomes, i.e., persistent typical recurrent epigastric or right upper quadrant pain with/without meals versus no pain. The primary outcome was the presence of pain 30 days after the cholecystectomy. Univariate analysis was performed with some of the bivariate indicators and continuous predictors, which contained fewer missing elements and had more variation.

Results

Univariate logistic regression suggested that HIDA GBEF as a continuous variable does not suggest a relationship with pain after surgery (p = 0.3951). A ROC analysis suggested a cutoff of HIDA GBEF = 16 (AUC = 0.60, Specificity = 0.5455, Sensitivity = 0.7333).

Conclusion

Our study does not support the relationship between GBEF found on HIDA scan to improved outcomes after the surgery. But larger controlled trials comparing outcomes of the patients with biliary dyskinesia who did and didn't undergo cholecystectomy are needed to look for other factors.