Sunday, September 26, 2004

Putting the Squeeze On...
Kevin strikes again with the New York Times take on acalculous biliary pain or biliary dyskinesia (BD). The concept of BD is that patients have pain similar to that of classical biliary colic due to stones, but have no gallstones on ultrasound. It is diagnosed with a CCK-HIDA scan which contracts the gallbladder. The cutoff is an EF of 35 percent. Oftentimes the patient will have a reproduction of their symptoms upon injection of the CCK.
I will often see these patients after a workup similar to that described in the story. I tell them that about 2/3 will get relief from the surgery. That looks to be a lowball figure based on the latest studies. Those that have some signs of chronic inflammation, such as adhesions, will stand a better chance of getting improvement. What is interesting is that the study Kevin cites, 85% of those with an EF> 35% had improvement. So line right up for your lap chole...

I will be the first to admit that BD fits the description of a "surgical nail". The whole concept of cholecystectomy for a non-calculous condition would be very hard to sell without the benefit of laparoscopy.
Cross-posted at Galen's Log
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