It is attractive to consider GBEF as the objective differentiator between those who may respond to cholecystectomy from those who are not likely to be helped by this surgery.
Application of GBEF in hospitalized patients who are typically acute, undergoing active medical treatment, and often suffering from nausea, abdominal pain and other gastrointestinal symptoms warrants a word of caution.
However, the majority of studies report high value of abnormal GBEF in predicting success of cholecystectomy for the pain relief, (34,58-66) while a minority offer opposing views.
(3) The low GBEF was included as the supportive criteria for the diagnosis of FGBD in 2016.
However, additional diagnostic testing may be useful in patients with atypical abdominal symptoms and cholelithiasis in order to affirm causal relationship by demonstrating abnormal GBEF. Administration of sincalide in patients with cholelithiasis could be viewed by some professionals as unsafe for the concern of dislodging a stone and precipitating biliary tract obstruction and/or pain.
In patients with chronic abdominal pain and abnormal GBEF on CCK-HBS, the pertinent information should be queried for the absence or presence of gallstones and/or sludge.
Current expert opinion based on the available data favors cholecystectomy for patients with biliary symptoms and an abnormal GBEF, and discourages cholecystectomy in cases involving atypical symptoms.
These data, although once again limited by the retrospective nature of the study, the heterogeneity of the pooled data, and the high risk of bias, suggest the need for reliable diagnostic criteria in the selection of patients for CCK-HIDA, since it is the combination or typical symptoms and an abnormal GBEF that provide the best chance of success with operation.
One such misconception is the assumption that the degree of lowering of GBEF is predictive of success.
(12) The ordering of CCKHIDA studies in patients with atypical symptoms not suggestive of functional biliary disorder should be discouraged, as some of these patients may indeed have an abnormal GBEF in the absence of disease.
* The use of CCK-HIDA scan (and GBEF) to select which patients with pain of biliary origin should undergo cholecystectomy is an acceptable practice under current Society of Gastrointestinal and Laparoendocopic Surgeons (SAGES) clinical guidelines.
* No data exist to suggest that symptom reproduction with CCK injection or degree of GBEF abnormality is predictive of relief of symptoms by cholecystectomy, and these criteria should not be used to select patients for surgery.