Biliary Dyskinesia Evaluation and Surgical Management
Summary
Biliary dyskinesia is a functional gallbladder disorder characterised by episodic biliary pain in the absence of stones or structural lesions. Patients typically present with right upper quadrant discomfort, often provoked by fatty meals. Initial evaluation includes thorough clinical assessment and ultrasound to exclude cholelithiasis or biliary obstruction. Functional testing relies on hepatobiliary iminodiacetic acid (HIDA) scintigraphy with a stimulant—either cholecystokinin or a standardised fatty meal—to measure gallbladder ejection fraction (GBEF). Traditionally, an EF below 35 per cent indicates hypokinesia, guiding selection for laparoscopic cholecystectomy. Emerging data support surgical intervention in patients with hyperkinetic gallbladder (EF ≥ 80 per cent) when clinical symptoms replicate on stimulation. Laparoscopic cholecystectomy remains the mainstay of management, yielding high rates of symptom resolution, though outcomes vary by patient selection and centre. Paediatric cohorts show greater heterogeneity in symptom profiles and poorer predictive value of GBEF, highlighting the need for uniform diagnostic criteria and prospective outcome studies. Overall, research is refining the thresholds for intervention and expanding indications for surgery beyond classical dysfunction.
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Biliary Dyskinesia Evaluation and Surgical Management publication trend
The graph below shows the total number of articles in biliary dyskinesia evaluation and surgical management across all publications each year (not limited to Nature Index journals).
Technical terms
Gallbladder ejection fraction (GBEF): The percentage of bile expelled from the gallbladder during a stimulant-induced contraction.
Hepatobiliary iminodiacetic acid (HIDA) scan: A nuclear medicine study assessing gallbladder and biliary tract function by tracking a radiolabelled tracer.
Cholecystokinin (CCK): A gastrointestinal hormone used to stimulate gallbladder contraction during functional imaging.
Hyperkinetic gallbladder: A functional state defined by abnormally high gallbladder ejection fraction, often ≥ 80 per cent, associated with biliary colic.
References
- Biliary Dyskinesia in Children and Adolescents: A Mini Review. Frontiers in Pediatrics (2020).
- Optimal hepatobiliary scintigraphy for gallbladder dyskinesia. Surgery Open Science (2020).
- The Role of Cholecystectomy in Hyperkinetic Gallbladder: A Retrospective Cohort Study in a Rural Hospital. Cureus (2022).
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