RT Journal
A1 Mahid SS, Jafri NS, Brangers BC, Minor KS, Hornung CA, Galandiuk S
T1 MEta-analysis of cholecystectomy in symptomatic patients with positive hepatobiliary iminodiacetic acid scan results without gallstones
JF Archives of Surgery
JO Archives of Surgery
YR 2009
FD February 1
VO 144
IS 2
SP 180
OP 187
DO 10.1001/archsurg.2008.543
UL http://dx.doi.org/10.1001/archsurg.2008.543
AB Objective 
    To study the clinical results of surgical management in patients with right upper quadrant pain, a positive hepatobiliary iminodiacetic acid (HIDA) scan result, and no gallstones.Data Sources 
    Health care databases and gray literature.Study Selection 
    Each article was scrutinized to determine whether it met inclusion criteria. Only abstracts, full articles, and gray literature that passed the detailed screening procedure were included. Case reports, letters, comments, reviews, and abstracts with insufficient details to meet inclusion criteria were excluded. Gallbladder ejection fraction assessed by means other than cholecystokinin HIDA scan were also excluded.Data Extraction 
    Three reviewers independently abstracted the following data from each article: first author, year of publication, journal, type of study, location of study population, institution where the study was conducted, symptoms recorded, imaging modality used to establish the absence of gallstones, HIDA scan ejection fraction, number of cases and controls, number of males and females in each group, method of follow-up, and number of cases lost to follow-up.Data Synthesis 
    Ten studies met inclusion criteria (N = 615). Follow-up ranged from 3 to 64 months. Surgical treatment was 15-fold more likely than medical treatment to result in symptom improvement, with 4% of patients reporting no symptom improvement with surgery. Sensitivity analysis in patients with complete symptom relief following surgery revealed an 8-fold greater odds difference than those treated medically (indicating variation in study reporting).Conclusions 
    Patients without gallstones who have right upper quadrant pain and a positive HIDA scan result are more likely to experience symptom relief following cholecystectomy than those treated medically. There is, however, wide variability in data reporting, particularly with respect to symptom relief and duration of follow-up. Cholecystectomy is indicated in symptomatic patients without gallstones who have a low–ejection fraction HIDA scan.