ABSTRACT
Recurrent ‘‘biliary’’ type pain is a perplexing clinical dilemma that occurs in two groups of patients. The first is in patients with an acalculous gallbladder in situ in which symptoms are identical to those in patients with cholelithiasis and biliary colic. The second is in patients who have undergone a previous cholecystectomy but continue to have recurrent episodes of pain that are similar in nature to biliary colic. In the first group of patients, attention is mostly centered on the gallbladder and deciding on the need for a cholecystectomy. In the second group, attention is directed more toward the sphincter of Oddi and deciding on the need for endoscopic sphincterotomy (ES). However, the pathogenesis of biliary type pain in either scenario is often uncertain, and consequently, evaluation and management remain controversial. This chapter addresses the broad topic of biliary type pain in both clinical settings with emphasis on evidence-based diagnostic testing and management strategies.
