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Plummer MP, Kar P, Cousins CE, Hausken T, Lange K, Chapman MJ, Jones KL, Horowitz M, Deane AM. Critical Illness Is Associated With Impaired Gallbladder Emptying as Assessed by 3D Ultrasound. Crit Care Med 2016; 44:e790-6. [PMID: 27071067 DOI: 10.1097/ccm.0000000000001715] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To quantify gallbladder dysfunction during critical illness. DESIGN Prospective observational comparison study of nutrient-stimulated gallbladder emptying in health and critical illness. SETTING Single-centre mixed medical/surgical ICU. PATIENTS Twenty-four mechanically ventilated critically ill patients suitable to receive enteral nutrition were compared with 12 healthy subjects. INTERVENTIONS Participants were studied after an 8-hour fast. Between 0 and 120 minutes, high-fat nutrient (20% intralipid) was infused via a postpyloric catheter into the duodenum at 2 kcal/min. MEASUREMENTS AND MAIN RESULTS Three-dimensional images of the gallbladder were acquired at 30-minute intervals from -30 to 180 minutes. Ejection fraction (%) was calculated as changes between 0 and 120 minutes. Blood samples were obtained at 30-minute intervals for plasma cholecystokinin. Data are mean (SD) or median [interquartile range]. In the critically ill, fasting gallbladder volumes (critically ill, 61 mL [36-100 mL] vs healthy, 22 mL [15-25] mL; p < 0.001] and wall thickness (0.45 mm [0.15 mm] vs 0.26 mm [0.08 mm]; p < 0.001] were substantially greater, and sludge was evident in the majority of patients (71% vs 0%). Nutrient-stimulated emptying was incomplete in the critically ill after 120 minutes but was essentially complete in the healthy individuals (22 mL [9-66 mL] vs 4 mL [3-5 mL]; p < 0.01]. In five critically ill patients (21%), there was no change in gallbladder volume in response to nutrient, and overall ejection fraction was reduced in the critically ill (50% [8-83%] vs 77 [72-84%]; p = 0.01]. There were no differences in fasting or incremental cholecystokinin concentrations. CONCLUSIONS Fasted critically ill patients have larger, thicker-walled gallbladders than healthy subjects and nutrient-stimulated gallbladder emptying is impaired with "gallbladder paresis" occurring in approximately 20%.
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Affiliation(s)
- Mark P Plummer
- 1Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.2Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, SA, Australia.3Department of Medicine, Haukeland University Hospital, Bergen, Norway.4Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
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3
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Abstract
Biliary disease in children has changed over the past few decades, with a marked rise in incidence-perhaps most related to the parallel rise in pediatric obesity-as well as a rise in cholecystectomy rates. In addition to stone disease (cholelithiasis), acalculous causes of gallbladder pain such as biliary dyskinesia, also appear to be on the rise and present diagnostic and treatment conundrums to surgeons.
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Affiliation(s)
- David H Rothstein
- Department of Pediatric Surgery, Women and Children׳s Hospital of Buffalo, 219 Bryant St, Buffalo, New York 14222; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Carroll M Harmon
- Department of Pediatric Surgery, Women and Children׳s Hospital of Buffalo, 219 Bryant St, Buffalo, New York 14222; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
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Serra C, Pallotti F, Bortolotti M, Caputo C, Felicani C, De Giorgio R, Barbara G, Nardi E, Labate AMM. A New Reliable Method for Evaluating Gallbladder Dynamics: The 3-Dimensional Sonographic Examination. JOURNAL OF ULTRASOUND IN MEDICINE 2016; 35:297-304. [PMID: 26740492 DOI: 10.7863/ultra.14.10033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/26/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purpose of this study was to compare conventional 2-dimensional (2D) B-mode sonography with 3-dimensional (3D) sonography for assessing gallbladder volume and contractility. METHODS Gallbladder volume and contractility were evaluated in 32 healthy volunteers after fasting and abstinence from smoking for 8 hours and after a standardized balanced liquid meal. The gallbladder was evaluated with 2D sonography (with the use of the ellipsoid method) and with 3D sonography using a volumetric matrix probe. Both measurements were made by an operator who was skilled in sonography and an unskilled operator. The group of volunteers was subdivided into 2 subgroups including 16 participants, which represented the "2 moments" of acquisition by the techniques, particularly for the unskilled operator. RESULTS The postprandial volumes obtained with 3D sonography were significantly lower in comparison to the volumes obtained with 2D sonography (P= .013), and there was a significant difference between the measurements made by the skilled and unskilled operators only for 2D sonography (P< .001), whereas between the 2 moments of acquisition by the 3D technique, there was no significant difference. The reproducibility of the technique for evaluation of gallbladder volumes was higher for 3D sonography than 2D sonography, particularly for the postprandial evaluation. CONCLUSIONS The new 3D sonographic method using a volumetric matrix probe is a simple, reliable, and more reproducible technique than conventional 2D sonography, even if performed by an unskilled operator, and it allows a reliable stimulation test for a gallbladder dynamic study.
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Affiliation(s)
- Carla Serra
- Department of Digestive System, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy (C.S., F.P., M.B., C.C., C.F., R.D.G., G.B.); and Laboratory of Biostatistics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (E.N., A.M.M.L.)
| | - Francesca Pallotti
- Department of Digestive System, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy (C.S., F.P., M.B., C.C., C.F., R.D.G., G.B.); and Laboratory of Biostatistics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (E.N., A.M.M.L.)
| | - Mauro Bortolotti
- Department of Digestive System, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy (C.S., F.P., M.B., C.C., C.F., R.D.G., G.B.); and Laboratory of Biostatistics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (E.N., A.M.M.L.).
| | - Carla Caputo
- Department of Digestive System, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy (C.S., F.P., M.B., C.C., C.F., R.D.G., G.B.); and Laboratory of Biostatistics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (E.N., A.M.M.L.)
| | - Cristina Felicani
- Department of Digestive System, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy (C.S., F.P., M.B., C.C., C.F., R.D.G., G.B.); and Laboratory of Biostatistics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (E.N., A.M.M.L.)
| | - Roberto De Giorgio
- Department of Digestive System, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy (C.S., F.P., M.B., C.C., C.F., R.D.G., G.B.); and Laboratory of Biostatistics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (E.N., A.M.M.L.)
| | - Giovanni Barbara
- Department of Digestive System, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy (C.S., F.P., M.B., C.C., C.F., R.D.G., G.B.); and Laboratory of Biostatistics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (E.N., A.M.M.L.)
| | - Elena Nardi
- Department of Digestive System, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy (C.S., F.P., M.B., C.C., C.F., R.D.G., G.B.); and Laboratory of Biostatistics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (E.N., A.M.M.L.)
| | - Antonio Maria Morselli Labate
- Department of Digestive System, Sant'Orsola-Malpighi Hospital and University of Bologna, Bologna, Italy (C.S., F.P., M.B., C.C., C.F., R.D.G., G.B.); and Laboratory of Biostatistics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy (E.N., A.M.M.L.)
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Goussous N, Kowdley GC, Sardana N, Spiegler E, Cunningham SC. Gallbladder dysfunction: how much longer will it be controversial? Digestion 2015; 90:147-54. [PMID: 25278145 DOI: 10.1159/000365844] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Motility disorders of the biliary tree [biliary dyskinesia, including both gallbladder dysfunction (GBD), and sphincter of Oddi dysfunction] are difficult to diagnose and to treat. SUMMARY There is controversy in the literature in particular regarding the criteria that should be used to select patients for cholecystectomy (CCY) in cases of suspected GBD. The current review covers the history, diagnosis, and treatment of GBD. Key Messages: Only >85% of patients with suspected GBD have relief following CCY, a much lower rate than the nearly 100% success rate following CCY for gallstone disease. Unfortunately, the literature is lacking, and there are no universally agreed-upon criteria for selecting which patients to refer for operation, although cholecystokinin (CCK)-enhanced hepatobiliary iminodiacetic acid scan is often used, with emphasis on an abnormally low gallbladder ejection fraction or pain reproduction at CCK administration. There is a clear need for large, well-designed, more definitive, prospective studies to better identify the indications for and efficacy of CCY in cases of GBD.
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Affiliation(s)
- Naeem Goussous
- Department of Surgery, Saint Agnes Hospital, Baltimore, Md., 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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