A telephone interview was also done to assess for change in abdominal symptoms after surgery or after the scan in those patients treated without surgery. All cholecystectomies were done laparoscopically. The main finding of our study is that patients with acalculous biliary pain and a decreased GBEF treated by cholecystectomy had a better outcome than those who were managed medically. Cholecystectomy for patients with normal gallbladder contractility is usually not necessary. We believe that when the GBEF is normal, cholecystectomy should be deferred until such a time when conservative management is deemed unsuccessful.
Several limitations exist with our study and the published studies cited in the Table.
Precise descriptions of pain characteristics were rarely provided. In most of the studies, the investigators who collected the follow-up data on patients were not blinded regarding the results of the biliary scintigraphic studies or to the type of treatment provided. Like our investigation, most were retrospective. The results of this study, summarized in the Table, are consistent with the findings of our retrospective study and most other studies. Another limitation is that the period of follow-up in our study and many of the others was relatively short.