Cholecystokinin cholecystography, sonography, and scintigraphy: detection of chronic acalculous cholecystitis

Davis, G.H.; Berk, RN; Scheible, F. William; Witztum, KF; It, Gilmore; Strong, R.; Hofmann, Andreas

doi:10.2214/ajr.139.6.1117

Cited by 29 publications

(18 citation statements)

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“…A review of the literature reveals that assessing outcomes of cholecystectomy for acalculous disease is fraught with methodological problems. All but three of the published studies are retrospective reviews 51), which have well-known limitations and are subject to potential bias. In two series the data were collected prospectively (7,50).…”

Section: Managementmentioning

confidence: 99%

“…Yap et al (6) performed cholecystectomy in 14 patients with a normal GEF, 8 (57%) of whom became asymptomatic. Davis et al (51) observed that patients with acalculous biliary-type pain had a mean GEF of 83% ± 17%, versus 68% ± 27% in normal volunteers. They concluded that the assessment of gallbladder contraction by any method is not a validated criterion for the presence of gallbladder disease.…”

Section: Managementmentioning

confidence: 99%

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Controversies Concerning Pathophysiology and Management of Acalculous Biliary-Type Abdominal Pain

et al. 2005

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Acalculous biliary-type abdominal pain is a commonly encountered clinical problem whose pathophysiology is unclear and evaluation and management are controversial. Cholecystokinin cholescintigraphy to measure the gallbladder ejection fraction (GEF) has been advocated as a criterion for cholecystectomy. However, there is no consensus regarding the dose and rate of infusion of cholecystokinin, both of which can alter the GEF, and the definition of an abnormal ejection fraction varies among studies. Many but not all studies have concluded that a low GEF predicts good outcomes after cholecystectomy, but most studies suffer from poor methodology and there is only one prospective randomized controlled trial. Also, some patients with a normal GEF have responded to cholecystectomy. Another controversial area has been the role of sphincter of Oddi dysfunction (SOD) in patients with biliary-type pain and gallbladder in situ. Some reports suggest an overlap between SOD and low GEF, although a causal relationship has not been established. Yet another subject of interest is the role of visceral hyperalgesia in patients with acalculous biliary-type pain. We have reviewed the relevant literature relating to these issues and have highlighted the controversial aspects. In the absence of high-quality studies, an evidence-based treatment algorithm is difficult to design but will be proposed. More prospective controlled trials are warranted to better define the appropriate evaluation and management of patients with this syndrome.

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Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Controversies Concerning Pathophysiology and Management of Acalculous Biliary-Type Abdominal Pain

et al. 2005

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“…To-date, US is often the initial imaging modality in critically ill patients who are suspected of having AC (1,(5)(6)(7)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)28). Despite the great variation in sensitivity and specificity for US diagnosis of AC (1, 5-7, 10-13, 16, 17, 19, 21-23, 26, 28), other imaging modalities are either not available in the ICU or do not perform superiorly to US (2,6,16,23,25).…”

Section: Resultsmentioning

confidence: 99%

“…Despite the great variation in sensitivity and specificity for US diagnosis of AC (1, 5-7, 10-13, 16, 17, 19, 21-23, 26, 28), other imaging modalities are either not available in the ICU or do not perform superiorly to US (2,6,16,23,25).…”

Section: Resultsmentioning

confidence: 99%

Sonomorphology of the gallbladder in critically ill patients

et al. 1997

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“…In fact, controversy surrounds the distinction between normal and abnormal EF values. The majority of published studies suggest delineation is at approximately 35% (FinkBennett, et al, 1991;Yap, et al, 1991;Chen, et al, 2001;Davis, et al, 1982;Topper, et al, 1980;Pickleman, et al, 1985;FinkBennett, et al, 1985;Misra, et al, 1991;Zech, et al, 1991;Barron, et al, 1995;Yost, et al, 1999;Middleton & Williams, 1999;Poynter, et al, 2002;Majeski, et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Hepatobiliary scanning standards fail to identify symptomatic patients with chronic acalculous cholecystitis

Stanley

Wright

Davenport

et al. 2015

MRAJ

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Background: Patients with chronic biliary colic-like pain and normal transabdominal ultrasonography (TUS) typically undergo nuclear hepatobiliary imaging (HIDA) with cholecystokinin (CCK) injection and gall bladder ejection fraction (EF) calculation to identify gallbladder dyskinesia. Most literature suggests EF≤35% indicates biliary dyskinesia. We hypothesize that presence of chronic biliary colic-like symptoms predicts favorable outcome after cholecystectomy (CCY) in patients with normal hepatobiliary imaging.

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Cholecystokinin cholecystography, sonography, and scintigraphy: detection of chronic acalculous cholecystitis

Cited by 29 publications

References 0 publications

Controversies Concerning Pathophysiology and Management of Acalculous Biliary-Type Abdominal Pain

Controversies Concerning Pathophysiology and Management of Acalculous Biliary-Type Abdominal Pain

Sonomorphology of the gallbladder in critically ill patients

Hepatobiliary scanning standards fail to identify symptomatic patients with chronic acalculous cholecystitis

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