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Keskin M, Çandar T, Çoban M, Ataç KG, Gürsoy AY, Çağlar GS. Evaluation of plasma cholecystokinin levels and gallbladder functions in hyperemesis gravidarum: a prospective cohort study. J OBSTET GYNAECOL 2022; 42:2463-2468. [DOI: 10.1080/01443615.2022.2054677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Müge Keskin
- Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Tuba Çandar
- Department of Clinical Biochemistry, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Çoban
- Department of Gastroenterology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Kaan Gökçe Ataç
- Department of Radiology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Aslı Yarci Gürsoy
- Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Gamze Sinem Çağlar
- Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, Turkey
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Li AY, Yue H, Kavnoudias H, Cherk MH, Nadebaum DP, Barton H, Beech P, Yap KSK, Smith M, Paul E, Barber TW. Clinical utility of stimulated cholescintigraphy using a standardized Ensure-Plus fatty meal protocol in patients with suspected functional gallbladder disorder: a retrospective study of seven-years clinical experience. ANZ J Surg 2021; 92:774-780. [PMID: 34850524 DOI: 10.1111/ans.17388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The clinical utility of fatty meal stimulated cholescintigraphy particularly using a standardized formulation in patients with suspected functional gallbladder disorder has not been extensively studied. We present our seven-year clinical experience using an Ensure plus protocol. METHODS A retrospective study was performed on patients undergoing stimulated cholescintigraphy using Ensure Plus for evaluation of suspected functional gallbladder disorder. A gallbladder ejection fraction (GBEF) of <33% was considered abnormal. RESULTS Of the 173 patients evaluated, 57 (33%) had an abnormal GBEF, 112 (65%) had a normal GBEF and 4 (2%) had no gallbladder visualization. Of the 57 patients with an abnormal GBEF, symptom improvement occurred in 30/31 (97%) who underwent cholecystectomy and in 17/26 (65%) who were managed conservatively (p = 0.003). Of the 112 patients with a normal GBEF, symptom improvement occurred in 8/10 (80%) who underwent cholecystectomy and 74/102 (73%) who were managed conservatively (p = 1.000). In the subgroup of 102 patients with a normal GBEF managed conservatively, those without symptomatic improvement had lower GBEFs compared to those with symptomatic improvement (median GBEF 46% versus 57%, p = 0.019). CONCLUSION Our retrospective results support a clinical role for stimulated cholescintigraphy using Ensure Plus in the evaluation of patients with suspected functional gallbladder disorder. While an abnormal GBEF predicts good surgical outcome, our results suggest that using an absolute GBEF cut off value of <33% may not apply to all patients and hence GBEF results should only be used as an adjunct in the surgical decision-making process.
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Affiliation(s)
- Acrane Y Li
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Helen Yue
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Helen Kavnoudias
- Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Martin H Cherk
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, Victoria, Australia
| | - David P Nadebaum
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Howard Barton
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul Beech
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kenneth S K Yap
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, Victoria, Australia
| | - Marty Smith
- Department of Hepatopancreaticobiliary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thomas W Barber
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, Victoria, Australia
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2015 UK software audit of hepatobiliary scintigraphy. Nucl Med Commun 2019; 40:136-144. [PMID: 30650067 DOI: 10.1097/mnm.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This audit investigated hepatobiliary function imaging in UK hospitals, reviewing protocol differences in acquisition and processing parameters and the effect on calculated gallbladder ejection fraction (GBEF). PARTICIPANTS AND METHODS Two dynamic data sets were available: one continuous dynamic data set, and the other with a 5-min break to administer the fatty stimulus. Participants used a set of 12 anonymized patient data sets most similar to their standard protocol calculating GBEF using their routine method. RESULTS Fifty-two UK centres responded. Across all centres for all data sets, there was large variability in GBEF quoted, mostly owing to variations in the calculation method, motion correction and imaging type/times. The largest contributor to GBEF variation was time acquired after stimulus which varied from 20 to 70 min. Only 48.1% centres acquired for 60 min after stimulus, which is the acquisition time stated in normal range references. Overall, 13.5% participating centres administered fatty stimuli that fell below the recommended 10 g. Widespread variations were found in GBEF normal ranges and fatty stimulus administration. Motion correction has a large effect on GBEF; in one data set, motion correction alone changed GBEF from 44 to 9%, but 25% of the participants stated motion correction was not used. CONCLUSION The authors proposed gold standard is fat content of the stimulus should be at least 10 g; and images should be acquired for 60 min after stimulus. If GBEF is quoted, motion correction should be used, and if compared with a normal range, the stimulus used must fit with the reference.
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Spangenberg B, van Rensburg JJ. Fatty meal sonography comparing coconut oil and chocolate bar with full-fat yoghurt as cholecystagogues for gallbladder ejection fractions. SA J Radiol 2018; 22:1312. [PMID: 31754497 PMCID: PMC6837805 DOI: 10.4102/sajr.v22i1.1312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background The authors compared the effectiveness of a chocolate bar and full-fat yoghurt combination to coconut oil in determining the gallbladder ejection fraction (GBEF). The clinical motive was functional gallbladder disorder (FGD) which has the clinical picture of symptomatic gallstones but without gallstones. Functional gallbladder disorder has a decreased GBEF of less than 35%. Gallbladder ejection fraction can be calculated by ultrasound, using cholecystokinin (CCK) as a stimulant for gallbladder contraction. Cholecystokinin is not available in South Africa, and the researchers compared a 60 g Snickers chocolate bar with 200 g full-fat yoghurt, against the theoretically superior coconut oil. Objectives To determine the efficacy of coconut oil versus chocolate bar and 200 g full-fat yoghurt combination in performing sonographic GBEFs. Method This was a randomised clinical experiment, before and after crossover trial. The three experimental components of the study included 15 g coconut oil, 20 g coconut oil and a standard fatty meal consisting of 60 g Snickers bar and 200 g full-fat yoghurt. Results The GBEF for the chocolate bar and yoghurt combination was the highest (62.84%). The GBEF for 20 g of coconut oil was 23.47% and for 15 g of coconut oil was 5.11%. There was a statistically significant difference between the chocolate and yoghurt combination and the 20 g coconut oil, as well as the chocolate yoghurt combination and the 15 g coconut oil, both with a p-value of < 0.0001. No statistically significant difference was found between the 20 g and 15 g coconut oil. Conclusions The 60 g Snickers chocolate bar and 200 g full-fat yoghurt combination was superior to the coconut oil. The authors advocate using the chocolate and yoghurt fatty meal oral stimulant to determine GBEF.
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Affiliation(s)
- Benjamin Spangenberg
- Department of Radiology, University of the Free State, South Africa
- Department of Clinical Imaging Sciences, Universitas Hospital, South Africa
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Rose JB, Fields RC, Strasberg SM. Poor Reproducibility of Gallbladder Ejection Fraction by Biliary Scintigraphy for Diagnosis of Biliary Dyskinesia. J Am Coll Surg 2018; 226:155-159. [DOI: 10.1016/j.jamcollsurg.2017.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 11/25/2022]
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Jain AS, Simon S, Muthukrishnan I, Mohan AT, Balsubramaniam R. Standardization of "In-House fatty meal" methodology for cholescintigraphy. Indian J Nucl Med 2015; 30:303-8. [PMID: 26430312 PMCID: PMC4579613 DOI: 10.4103/0972-3919.164021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM This study was aimed at standardizing the "In-House fatty meal" methodology in cholescintigraphy and to determine gall bladder ejection fraction (GBEF) with this standardized meal. MATERIALS AND METHODS This is a prospective case-control study where 61 patients having right upper quadrant pain and postprandial bloating and 59 healthy volunteers were included. They underwent (99m)Tc-mebrofenin fatty meal cholescintigraphy following a standard protocol. Dynamic acquisitions over 120 min were done, with a fatty meal being given between 45- and 60-min. Gallbladder emptying kinetics was studied by assessing the time activity curves and calculation of GBEFs were made at 30-min, 45-min, and at 60-min and assessed. RESULTS The GBEF at 30-min was 74.42% ± 8.26% (mean ± standard deviation), at 45-min was 82.61% ± 6.5%, and at 60-min was 89.37% ± 4.48% in the volunteer group. The lower limit of GBEF in volunteers at 30-min was 58%, 45-min was 69%, and at 60-min was 81%. Receiver operating characteristic (ROC) analysis showed that 30-min GBEF provided the best separation between healthy and diseased subjects with an area under curve of 0.952 (95% confidence interval = 0.914-0.989). The lower limit of GBEF at 30-min was 58%. CONCLUSIONS An in-House standard fatty meal could be a reproducible alternative to cholecystokinin as it is well-tolerated. Based on ROC curve analysis, we propose that 30-min GBEF provides good separation between healthy and diseased people with this in-House fatty meal. Hence, dynamic acquisitions beyond 30-min postingestion of the fatty meal may not be warranted.
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Affiliation(s)
- Avani S Jain
- Department of Nuclear Medicine and PET CT, Apollo Main Hospitals, Chennai, Tamil Nadu, India
| | - Shelley Simon
- Department of Nuclear Medicine and PET CT, Apollo Main Hospitals, Chennai, Tamil Nadu, India
| | - Indirani Muthukrishnan
- Department of Nuclear Medicine and PET CT, Apollo Main Hospitals, Chennai, Tamil Nadu, India
| | - A T Mohan
- Department of Gastroenterology, Apollo Hospitals, Chennai, Tamil Nadu, India
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Eckenrode AH, Ewing JA, Kotrady J, Hale AL, Smith DE. HIDA Scan with Ejection Fraction is over Utilized in the Management of Biliary Dyskinesia. Am Surg 2015. [DOI: 10.1177/000313481508100714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with upper abdominal pain, nausea, and vomiting are often evaluated with ultrasound to diagnose symptomatic cholelithiasis or cholecystitis. With a normal ultrasound, a hepatobiliary iminodiacetic acid (HIDA) scan with ejection fraction (EF) is recommended to evaluate gallbladder function. The purpose of this study was to evaluate whether the HIDA scan with EF was appropriately utilized in considering cholecystectomy. Over 18 months, we performed 1533 HIDA scans with EF. After exclusion, 1501 were analyzable, 438 of whom underwent laparoscopic cholecystectomy. Patients were divided into two groups: those with typical and atypical symptoms of biliary colic. Our primary endpoint was symptom resolution of those who underwent laparoscopic cholecystectomy. Symptom resolution was assessed by chart review of postop visits or readmissions. In patients with typical symptoms, resolution occurred in 66 per cent of patients with positive HIDA and 77 per cent with negative HIDA ( P = 0.292). In patients with atypical symptoms, resolution occurred in 64 per cent of patients with positive HIDA and 43 per cent with negative HIDA ( P = 0.013). A HIDA scan with EF was not useful in patients with typical symptoms of biliary colic and negative ultrasounds, and should not be used to make a decision for cholecystectomy. However, this test can be helpful in patients with atypical symptoms, as it does predict symptom improvement in this group.
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Affiliation(s)
| | | | | | | | - Dane E. Smith
- Greenville Health System, Greenville, South Carolina
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Bielefeldt K, Saligram S, Zickmund SL, Dudekula A, Olyaee M, Yadav D. Cholecystectomy for biliary dyskinesia: how did we get there? Dig Dis Sci 2014; 59:2850-63. [PMID: 25193389 DOI: 10.1007/s10620-014-3342-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/19/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The focus of biliary dyskinesia (BD) shifted within the last 30 years, moving from symptoms after cholecystectomy (CCY) to symptoms with morphological normal gallbladder, but low gallbladder ejection fraction. METHODS We searched the pubmed database to systematically review studies focusing on the diagnosis and treatment of gallbladder dysfunction. RESULTS Impaired gallbladder contraction can be found in about 20% of healthy controls and an even higher number of patients with various other disorders. Surgery for BD increased after introduction of laparoscopic CCY, with BD now accounting for >20% of CCY in adults and up to 60% in pediatric patients. The majority of cases reported were operated in the USA, which differs from surgical series for cholelithiasis. Postoperative outcomes do not differ between groups with abnormal or normal gallbladder function. CONCLUSION Functional gallbladder testing should not be seen as an indicator of relevant biliary tract disease or prognostic marker to identify patients who may benefit from operative intervention. Instead biliary dyskinesia should be considered as a part of a spectrum of functional disorders, which are generally managed conservatively. Small proof of concept studies have demonstrated effects of medical therapy on biliary dysfunction and should thus be never tested in appropriately designed trials.
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Affiliation(s)
- Klaus Bielefeldt
- Divisions of Gastroenterology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA, 15213, USA,
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Lee JK, Kim Y, Lee S, Park JE. Hepatobiliary phase of gadoxetic acid-enhanced MR in patients suspected of having gallbladder dyskinesia: comparison with hepatobiliary scintigraphy. Clin Imaging 2014; 39:66-71. [PMID: 25457533 DOI: 10.1016/j.clinimag.2014.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/06/2014] [Accepted: 08/29/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance (HMR) and hepatobiliary scintigraphy (HBS) for evaluation of cystic duct patency and gallbladder contractility in patients suspected of having gallbladder dyskinesia. MATERIALS AND METHODS Eighteen patients underwent HMR and HBS. Cystic duct patency and gallbladder ejection fraction (GBEF) were compared to determine a significant difference between HMR and HBS. RESULTS HMR and HBS had 15 concordant and 3 discordant results for cystic duct patency. GBEF in eight patients showed no significant difference between both modalities. CONCLUSION HMR may be an alternative to HBS for the functional evaluation of cystic duct patency and GBEF.
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Affiliation(s)
- Jeong Kyong Lee
- Department of Radiology, School of Medicine, Ewha Womans University, 911-1 Mokdong, Yangcheon-gu, Seoul, 158-710, Korea.
| | - Yookyung Kim
- Department of Radiology, School of Medicine, Ewha Womans University, 911-1 Mokdong, Yangcheon-gu, Seoul, 158-710, Korea
| | - Sangmin Lee
- Department of Radiology, School of Medicine, Ewha Womans University, 911-1 Mokdong, Yangcheon-gu, Seoul, 158-710, Korea
| | - Ji Eun Park
- Department of Radiology, School of Medicine, Ewha Womans University, 911-1 Mokdong, Yangcheon-gu, Seoul, 158-710, Korea
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Lee SW, Cha SH, Chung HH, Kim KH, Yeom SK, Seo BK, Je BK, Kim BH. Functional magnetic resonance cholangiography with Gd-EOB-DTPA: a study in healthy volunteers. Magn Reson Imaging 2014; 32:385-91. [PMID: 24529920 DOI: 10.1016/j.mri.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/18/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe the patterns of bile distribution in the biliary tree, duodenum, jejunum, and stomach, and to determine the gallbladder ejection fraction (GBEF) by using functional magnetic resonance cholangiography (MRC) with gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) in healthy volunteers. MATERIALS AND METHODS Forty subjects were included in this study. After conventional MRC, pre-fatty meal MRC (PRFM) was obtained at 30, 40, 50, and 60min after contrast agent injection. Then, post-fatty meal MRC (POFM) was obtained every 10min for 1h. We assessed the PRFM and POFM for opacification of contrast agent in the first- and second-order intrahepatic ducts (IHDs) and the common bile duct (CBD). Contrast agent opacification in the cystic duct was assessed, and the percentage volume of contrast agent filling in the gallbladder (GB) was calculated on PRFM. We calculated the GBEF and assessed the presence of contrast agent in the GB, duodenum, jejunum, and stomach. RESULTS Thirty-six (90%) subjects showed grade 3 CBD opacification (visible contrast and well-defined bile duct border) on 60-min PRFM. Thirty-four (85%) subjects showed grade 3 first-order IHD opacification on 60-min PRFM. All (100%) subjects showed cystic duct opacification of contrast agent, and the average percentage volume of contrast agent filling in the GB was 68.81%±16.84% on 60-min PRFM. The GBEF at 30-min POFM was 35.00%±18.26%. Ten (25%) subjects had no contrast agent in the stomach and small bowel on all PRFMs. Twelve (30%) subjects had contrast medium in the stomach on PRFM and/or POFM. CONCLUSIONS Functional MRC with Gd-EOB-DTPA can allow determining the distribution of bile in the biliary tree and small intestine, as well as the GBEF.
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Affiliation(s)
- Seung Wha Lee
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707.
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Kee Hwan Kim
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Suk Keu Yeom
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Bo Kyung Seo
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Bo Kyung Je
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
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Aggarwal N, Bielefeldt K. Diagnostic stringency and healthcare needs in patients with biliary dyskinesia. Dig Dis Sci 2013; 58:2799-808. [PMID: 23934412 DOI: 10.1007/s10620-013-2719-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 05/08/2013] [Indexed: 12/15/2022]
Abstract
AIM We have recently shown an increase in cholecystectomies for biliary dyskinesia. Based on these results, we hypothesized that diagnostic criteria are less stringently applied which may contribute to ongoing resource utilization. METHODS Using billing codes, patients seen for biliary dyskinesia were identified and data were extracted from the electronic medical record to confirm the diagnosis, obtain demographic and clinical data and assess resource utilization 1 year prior to and after cholecystectomy. RESULTS A total of 972 patients were identified, with 894 undergoing cholecystectomy. In 259 patients, symptoms had started <3 months prior to evaluation. Functional gallbladder imaging revealed a mean gallbladder ejection fraction of 23.1 ± 0.7 %; of the patients undergoing surgery, 116 had a normal gallbladder ejection fraction. Sufficient up data for pre- and post-operative assessment of resource utilization was available for 368 patients. Emergency room (ER) visits decreased from 0.86 ± 0.07 to 0.69 ± 0.03 (P < 0.05), while hospitalization rates remained unchanged after surgery. Patients not meeting consensus criteria for the diagnosis of biliary dyskinesia were more likely to use opioids and have ER visits prior to and after cholecystectomy. Using multiple logistic regression benzodiazepine use, migraine history and prior ER visits independently predicted postoperative resource utilization. CONCLUSIONS Our data demonstrate that a significant number of patients undergo cholecystectomy for biliary dyskinesia, even though they do not meet currently accepted diagnostic criteria. While healthcare resource utilization drops within the first year after surgery, ER visits and hospitalizations remain common, suggesting a more limited benefit of surgical approaches in these patients.
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Affiliation(s)
- Nitin Aggarwal
- Division of Gastroenterology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA, 15213, USA
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Santhosh S, Mittal BR, Arun S, Sood A, Bhattacharya A, Kochhar R. Quantitative cholescintigraphy with fatty meal in the diagnosis of sphincter of Oddi dysfunction and acalculous cholecystopathy. Indian J Gastroenterol 2012; 31:186-90. [PMID: 22941730 DOI: 10.1007/s12664-012-0241-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 07/27/2012] [Indexed: 02/04/2023]
Abstract
To evaluate the role of quantitative cholescintigraphy with fatty meal in the management of biliary dyskinesia and to describe the findings according to Sostre score (SS) criteria in patients with gallbladder (GB) in-situ and biliary pain. We performed a retrospective analysis of the hepatobiliary (HIDA) studies (n = 35) performed for evaluation of biliary dyskinesia either due to biliary pain, opioid induced sphincter of Oddi dysfunction (SOD), recurrent pancreatitis (RP) or post cholecystectomy syndrome (PCS). Gallbladder ejection fraction (GBEF) was calculated from the post fatty meal HIDA images (excluding PCS patients). Studies with GBEF ≤40 % and SS >4 were considered to have cholecystopathy and SOD respectively. Three of the 13 patients with PCS had SS of 6 each, suggestive of SOD. Delayed biliary visualization (>15 min) and activity in common bile duct 60 min > liver 15 min were the specific features in these cases. Opioid induced SOD patients had SS >4 with retrograde refilling of GB in one patient and normalization of the SS parameters after nifedipine challenge in the other patient. Patients with RP and biliary pain were stratified into four groups, normal (GBEF >40 % and SS ≤4), cholecystopathy (GBEF ≤40 % and SS ≤4), normal with SOD (GBEF >40 % and SS >4) and cholecystopathy with SOD (GBEF ≤40 % and SS >4). Four patients with intact GB had cholecystopathy with scintigraphic features of SOD. Quantitative cholescintigraphy with fatty meal and SS scoring identified biliary dyskinesia and SOD in patients with biliary pain, recurrent pancreatitis and post-cholecystectomy syndrome.
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Affiliation(s)
- Sampath Santhosh
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
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Othman SA. Right upper quadrant pain with normal hepatobiliary ultrasound: can hepatobiliary scintigraphy define the cause? Saudi J Gastroenterol 2012; 18:248-51. [PMID: 22824767 PMCID: PMC3409885 DOI: 10.4103/1319-3767.98429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/AIM The objective of this study was to assess the value of hepatobiliary scintigraphy (HS) for the diagnosis of right upper quadrant (RUQ) abdominal pain in patients with normal hepatobiliary ultrasound (HU). This is an observational study with a retrospective analysis of data from March 2008 to August 2010. MATERIALS AND METHODS We reviewed the HS results of 30 patients, aged 29-69 years (average 45.8 years); 12 male and 18 female patients. Patient selection to perform the HS was RUQ abdominal pain, suspected hepatobiliary disorder, and negative HU. All patients had gone through the standard procedure of HS. RESULTS Based on predefined interpretation criteria, HS results were divided into 2 patterns: Normal (n=8, 25.8%) and abnormal (n=22, 73%): 18 patients (81.8%) having early gallbladder (GB) and common bile duct visualization, and delayed transit to small bowel (SB), which can be seen only after a fatty meal with normal or abnormal GB ejection fraction (GBEF) pattern characteristic of Oddi's sphincter dyskinesia. The remaining 4 patients (8.18%) had acalculous cholycystitis pattern: Delayed GB visualization with activity appearing in SB before GB. CONCLUSION HS with fatty meal stimulation and GBEF estimation seems to be a reliable test, which may reveal a biliary cause in more than 70% of patients with RUQ abdominal pain and normal HU. Normal results exclude functional biliary cause. The decision for invasive or noninvasive therapeutic approach may depend on the results of HS.
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Affiliation(s)
- Saleh A. Othman
- Department of Radiology and Medical Imaging, King Khalid University Hospital and College of Medicine, King Saud University, Riyadh, Saudi Arabia,Address for correspondence: Dr. Saleh Othman, Department of Radiology and Medical Imaging, King Khalid University Hospital and College of Medicine, King Saud University, Riyadh - 11472, Saudi Arabia. E-mail:
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Hokama A, Kishimoto K, Ihama Y, Chinen H, Kinjo F, Fujita J. Gallbladder dysfunction diagnosed by cholescintigraphy with a Fatty meal. Gut Liver 2011; 4:556-7. [PMID: 21253309 DOI: 10.5009/gnl.2010.4.4.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 07/06/2010] [Indexed: 11/04/2022] Open
Affiliation(s)
- Akira Hokama
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
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Al-Muqbel KM, Bani Hani MN, Elheis MA, Al-Omari MH. Reproducibility of gallbladder ejection fraction measured by Fatty meal cholescintigraphy. Nucl Med Mol Imaging 2010; 44:246-51. [PMID: 24899960 DOI: 10.1007/s13139-010-0046-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 07/15/2010] [Accepted: 08/01/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE There are conflicting data in the literature regarding the reproducibility of the gallbladder ejection fraction (GBEF) measured by fatty meal cholescintigraphy (CS). We aimed to test the reproducibility of GBEF measured by fatty meal CS. METHODS Thirty-five subjects (25 healthy volunteers and 10 patients with chronic abdominal pain) underwent fatty meal CS twice in order to measure GBEF1 and GBEF2. The healthy volunteers underwent a repeat scan within 1-13 months from the first scan. The patients underwent a repeat scan within 1-4 years from the first scan and were not found to have chronic acalculous cholecystitis (CAC). Our standard fatty meal was composed of a 60-g Snickers chocolate bar and 200 ml full-fat yogurt. RESULTS The mean ± SD values for GBEF1 and GBEF2 were 52 ± 17% and 52 ± 16%, respectively. There was a direct linear correlation between the values of GBEF1 and GBEF2 for the subjects, with a correlation coefficient of 0.509 (p = 0.002). Subgroup data analysis of the volunteer group showed that there was significant linear correlation between volunteer values of GBEF1 and GBEF2, with a correlation coefficient of 0.473 (p = 0.017). Subgroup data analysis of the non-CAC patient group showed no significant correlation between patient values of GBEF1 and GBEF2, likely due to limited sample size. CONCLUSIONS This study showed that fatty meal CS is a reliable test in gallbladder motility evaluation and that GBEF measured by fatty meal CS is reproducible.
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Affiliation(s)
- Kusai M Al-Muqbel
- Department of Radiology and Nuclear Medicine, School of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110 Jordan
| | - Mohammed N Bani Hani
- Department of General Surgery, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mwaffaq A Elheis
- Department of Radiology and Nuclear Medicine, School of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110 Jordan
| | - Ma'moon H Al-Omari
- Department of Radiology and Nuclear Medicine, School of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110 Jordan
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Gallbladder ejection fraction measured by fatty meal cholescintigraphy: is it affected by extended gallbladder emptying data acquisition time? Ann Nucl Med 2009; 24:29-34. [DOI: 10.1007/s12149-009-0324-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 11/02/2009] [Indexed: 11/28/2022]
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Diagnostic value of gallbladder emptying variables in chronic acalculous cholecystitis as assessed by fatty meal cholescintigraphy. Nucl Med Commun 2009; 30:669-74. [DOI: 10.1097/mnm.0b013e32832fd10a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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