TITLE

DOES BETHANECHOL PROVOCATION TESTING (BPT) PREDICT SYMPTOM RELIEF AFTER CHOLECYSTECTOMY FOR ACALCULOUS BILIARY PAIN?

AUTHOR(S)
Smythe, A.; Majeed, A.W.; Ahmed, R.; Fitzhenry, M.; Johnson, A.G.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA22
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction and Aims: We have previously shown that cholecystokinin provocation testing does not predict symptomatic benefit tram cholecystectomy in patients with acalculous biliary pain (ABP). Bethanechol is a muscarinic agent, which stimulates the gall bladder in vitro. The aim of this study was to evaluate the value of BPT in patients with acalculous biliary pain as a predictor of symptom relief after cholecystectomy. Methods: 51 patients with ABP were given saline and bethanechol (given s/c in a dose 0.50 µg/kg) to provoke biliary pain (blinded). If pain was reproduced with bethanechol, patients were classed as BPT+ve. If pain was not reproduced with either saline or bethanechol, patients were classed as BPT-ve. If pain was reproduced with saline, bethanechol was not given and patients were analysed separately. Percentage gall bladder emptying was monitored with serial ultrasonography. All patients were offered cholecystectomy irrespective of the outcome of the BPT and symptoms were re-assessed at 6 months. Results: 20 patients were BPT+ve and 24 patients were BPT-ve. Percentage gall bladder emptying (mean±SD) was similar in both groups (BPT+ve: 30%+16%, BPT-ve: 32±16%, p = 0.7). 17/20 BPT+ve patients underwent cholecystectomy of whom 9 (53%) remained symptomatic 6 months after operation. 11/24 BPT-ve patients underwent cholecystectomy and 6 (54%) remained symptomatic. 2/20 BPT+ patients did not undergo cholecystectomy and were subsequently lost to follow up. 9/24 BPT patients did not undergo cholecystectomy, of these 7 patients had spontaneous reduction in symptoms at 6 months. Of 7 patients positive for saline, five underwent cholecystectomy and two remained symptomatic. Conclusion: Bethanechol provocation of gall bladder symptoms in patients with ABP does not predict symptom relief at 6 months after cholecystectomy.
ACCESSION #
9747405

 

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