Cholescintigraphy may have a role in selecting patients with biliary dyskinesia for cholecystectomy: a systematic review

Alhayo, Sam; Eslick, Guy D.; Cox, Michael R.

doi:10.1111/ans.16003

Cited by 4 publications

(10 citation statements)

References 48 publications

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“…GBEF was calculated using the gallbladder maximum activity minus the minimum activity then dividing by the maximum activity. A GBEF of <33% was reported as abnormal 3 …”

Section: Methodsmentioning

confidence: 99%

“…A GBEF of <33% was reported as abnormal. 3 Clinical follow-up Follow-up was performed using a questionnaire evaluating global symptoms both before cholescintigraphy and at a minimum of 3 months after scanning or 3 months after surgery in patients treated with cholecystectomy. The questionnaire consisted of a 4-point symptom score with global symptoms graded as none, little, moderate or strong (Appendix 1).…”

Section: Stimulated Cholescintigraphymentioning

confidence: 99%

“…However, given that clinical presentation is often atypical, cholescintigraphy is a frequently used tool in guiding surgical management. 3 While stimulated cholescintigraphy using cholecystokinin (CCK) has been considered the 'gold standard' method for assessing gallbladder function, recent variable availability of synthetic CCK analogues has prompted many institutions to adopt fatty meal stimulation as an alternative. A variety of fatty meal protocols are used in clinical practice, but these differ in terms of fat, carbohydrate and caloric content.…”

Section: Introductionmentioning

confidence: 99%

“…Supportive criteria for functional gallbladder disorder include low gallbladder ejection fraction (GBEF) on cholescintigraphy as well as normal liver enzymes, conjugated bilirubin, and amylase/lipase levels. However, given that clinical presentation is often atypical, cholescintigraphy is a frequently used tool in guiding surgical management 3 . While stimulated cholescintigraphy using cholecystokinin (CCK) has been considered the ‘gold standard’ method for assessing gallbladder function, recent variable availability of synthetic CCK analogues has prompted many institutions to adopt fatty meal stimulation as an alternative.…”

Section: Introductionmentioning

confidence: 99%

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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

Yue

Kavnoudias

et al. 2021

ANZ Journal of Surgery

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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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“…GBEF was calculated using the gallbladder maximum activity minus the minimum activity then dividing by the maximum activity. A GBEF of <33% was reported as abnormal 3 …”

Section: Methodsmentioning

confidence: 99%

Section: Stimulated Cholescintigraphymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Yue

Kavnoudias

et al. 2021

ANZ Journal of Surgery

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“…Patients formally diagnosed were found to comprise up to 2%-8% of individuals undergoing cholecystectomy. 4 The management of gallbladder dyskinesia has been historically controversial. Laparoscopic cholecystectomy (LC) seems to be a mainstay of management in a selected group of patients.…”

mentioning

confidence: 99%

The impact of cholecystectomy on the symptom relief and quality of life of patients with gallbladder dysmotility

Alamin,

Iqbal,

Baumert

et al. 2024

World j. surg.

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BackgroundThe aim of this study was to demonstrate the impact of laparoscopic cholecystectomy on the physical and mental health of patients with gallbladder dysmotility.MethodsRetrospective data was collected from 314 patients who had undergone a hepatobiliary iminodiacetic acid (HIDA) scan between June 2012 and June 2022 in a District General Hospital in South East England. Sixty‐three patients who were diagnosed with gallbladder dysmotility were then contacted and asked to participate in a telephone interview regarding their symptoms. We measured their health‐related quality of life using the HRQoL SF‐12 v2 (Health Related Quality of Life Short Form‐12 version 2) questionnaire. Differences in the resolution of symptoms between those that had undergone a cholecystectomy and those who did not, were assessed using a chi square test. The two groups were then compared using the student t‐test to assess statistically significant differences.Results94% (n = 31/33) of the participants in the non‐cholecystectomy group demonstrated persistent biliary pain symptoms as opposed to the 6% (n = 2/30) in the cholecystectomy group. A statistically significant improvement in five out of the eight domains of the HRQoL SF‐12 questionnaire was demonstrated. These domains include PCS (physical component summary), MCS (mental component summary), mental health, general health and bodily pain.ConclusionThe results of our retrospective analysis demonstrate an improvement in both the physical and mental health‐related quality of life symptoms in patients who underwent laparoscopic cholecystectomy. These findings support the use of laparoscopic cholecystectomy as an effective method for managing gallbladder dysmotility.

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Biliary Dyskinesia—Controversies, Diagnosis, and Management

Richmond

2024

JAMA Surg

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ImportanceBiliary dyskinesia is a disorder characterized by biliary pain, a sonographically normal gallbladder, and a reduced gallbladder ejection fraction on cholecystokinin-cholescintigraphy (CCK-HIDA) scan. Laparoscopic cholecystectomy remains a common treatment for biliary dyskinesia despite a lack of high-quality evidence supporting the practice. The following review summarizes the current biliary dyskinesia outcomes data, the diagnostic strategies and their limitations, biliary dyskinesia in the pediatric population, the emerging phenomenon of the hyperkinetic gallbladder, and suggestions for addressing identified knowledge gaps.ObservationsThe majority of studies on the topic are retrospective, with wide variations in inclusion criteria and definition of biliary pain. Most report a very short follow-up interval, often a single office visit, with variable and nonstandardized definitions of a satisfactory outcome. Despite a published Society of Nuclear Medicine guideline for its performance, CCK-HIDA scan protocols vary among institutions, which has led to considerable variability in the consistency and reproducibility of CCK-HIDA results. The few prospective studies available, although small and heterogeneous, support a role for cholecystectomy in the treatment of adult biliary dyskinesia. Despite these knowledge gaps, biliary dyskinesia is now the number 1 indication for cholecystectomy in children. Cholecystectomy for the hyperkinetic gallbladder appears to be an emerging phenomenon, despite, as in biliary dyskinesia, a lack of quality data supporting this practice. Randomized trials addressing these gaps are needed but have been difficult to conduct owing to strong clinician and patient bias toward surgery and the lack of a criterion-standard nonsurgical treatment for the control arm.Conclusions and RelevanceThe use of cholecystectomy for adult biliary dyskinesia is reasonable based on the available data. Insufficient data exist regarding laparoscopic cholecystectomy for pediatric dyskinesia and the hyperkinetic gallbladder population. Large-scale prospective studies, either randomized trials or large prospectively followed cohort studies, are needed to address the knowledge gaps surrounding this controversial diagnosis.

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Cholescintigraphy may have a role in selecting patients with biliary dyskinesia for cholecystectomy: a systematic review

Cited by 4 publications

References 48 publications

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

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

The impact of cholecystectomy on the symptom relief and quality of life of patients with gallbladder dysmotility

Biliary Dyskinesia—Controversies, Diagnosis, and Management

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