297 Biliary Hyperkinesia: A Diagnostic Curiosity or a Surgical Indication?

Abstract Aim Biliary hyperkinesia (BH) is defined by biliary-type pain in the absence of gallstones, with a gallbladder ejection fraction (EF) >80% on hepatobiliary scintigraphy (HIDA). Although the pathophysiology remains uncertain, emerging evidence suggests that laparoscopic cholecystectomy (LC) may benefit selected patients. This study aimed to determine the prevalence of BH on HIDA scan and identify potential surgical candidates. Method A retrospective cohort study was conducted across three hospital sites, reviewing adult patients who underwent HIDA scanning from 2011 to 2023. Patients with EF >80% were followed for up to 2 years. Data collected included demographics, BMI, smoking status, symptom duration, liver function tests, cross-sectional imaging, and endoscopic findings. Patients with gallstones, microlithiasis, or postoperative bile leak were excluded. Results Of 348 patients, 59 (16.9%) had an EF >80%. Median age was 46.9 years (IQR 37–59), with 44 (78.5%) female. Right upper quadrant pain was more common than epigastric pain, often with associated dyspepsia. Median symptom duration was 15 months. Six patients underwent LC. One had delayed LC after an interval gallstone detection. Two had microlithiasis on EUS; histology confirmed chronic cholecystitis. One is under surveillance, while five had no documented follow-up. Conclusions BH remains under-recognised and often overlooked as a surgical diagnosis. Rapid gallbladder emptying may contribute to pain via transient biliary hypertension and mucosal injury. EUS should be considered to exclude occult microlithiasis before diagnosing BH and considering cholecystectomy.