Role of 99mTc-HIDA Scan for Assessment of Gallbladder Dyskinesia and Comparison of Gallbladder Dyskinesia with Various Parameters in Laparoscopic Cholecystectomy Patients

Abstract

Objectives. Pathogenesis of gallstone includes bile stasis due to defect in the gallbladder muscle contraction. Our aim of the study is to find out the role of 99mTc-HIDA scan in assessment of gallbladder dyskinesia in cholelithiasis patients before laparoscopic cholecystectomy and compare the gallbladder dyskinesia with various parameters like symptoms of patients, diabetic status of patients, gallstones size and number, and cholecystitis features in histopathology report after surgery. Material and Method. This is a prospective observational study conducted at our hospital for three years. Totally 40 patients with gallstone were subjected to 99mTc-HIDA scan, to assess the ejection fraction of gallbladder. For all these patients detailed clinical history, presence of comorbid illness like diabetics, and symptomatology were elicited. For all patients, ultrasonogram of abdomen was done to assess number and size of stones. All parameters were tabulated and correlated. Result. While comparing 99mTc-HIDA scan findings with symptoms of patients, 21.2% were asymptomatic and 78.8% symptomatic patients who had ejection fraction less than 80%. All patients in EF >80% group were symptomatic only. It is not statistically significant. On comparing 99mTc-HIDA scan findings with diabetic status of the patients, 42.4% of diabetic and 57.6 % of nondiabetic patients had ejection fraction less than 80%. It is not statistically significant (0.681). While comparing 99mTc-HIDA scan findings with size of the gallstone in ultrasound, 63.6% patients with size less than 1cm and 36.4% with size more than 1cm had ejection fraction < 80%. It is statistically significant (0.048). On comparing 99mTc-HIDA scan findings with number of stones in ultrasound, 18.2% single gallstone patients and 81.8% multiple gallstone patients had EF less than 80% which is statistically significant (0.001). While comparing the 99mTc-HIDA scan findings with histopathology report after laparoscopic cholecystectomy, 21.2% non-cholecystitis patients and 78.8% cholecystitis patients had EF less than 80%, which is statistically (0.017) significant. Conclusion. 99mTc-HIDA scan can be an accurate method to diagnose the gallbladder dyskinesia. Gallbladder dyskinesia in 99mTc-HIDA scan can be used to predict large size stones and multiple stones before surgery. The sensitivity can be improved by 99mTc-HIDA scan in diagnosing cholecystitis patients.

Postoperative Acute Pancreatitis in a Patient Who Underwent Laparoscopic Cholecystectomy: A Case Report

“…It is a useful tool for diagnosis of dyskinesia, small and multiple stones before surgery, but also could have some importance after surgery to diagnose some bile problems. 12 In the case of the patient, a minimal amount of bile leakage is shown; however, she did not require treatment at that time, so she was discharged and controlled in 1 week.…”

Biliary Hyperkinesia and Its Association With Bariatric Surgery: A Case Report and Review of Management Strategies

“…Among the many common complications of bariatric surgery, increased gastric motility manipulates GI hormone production [ 10 ]. The hormone of focus in this study is CCK, which is secreted by duodenal I cells in response to gastric emptying and leads to gallbladder contraction and relaxation of the sphincter of Oddi [ 5 ]. However, this hormone also delays gastric emptying in persons with increased gastric motility.…”

“…In this case, we use cholecystokinin 99m technetium-labeled hepatoiminodiacetic acid (99mTc-HIDA (CCK-HIDA)) for the patient’s workup as studies have shown it is the most accurate modality for diagnosing gallbladder disease by determining gallbladder contractility and ejection fraction (EF) [ 5 ]. Gallbladder hypomotility also known as biliary dyskinesia is a common functional biliary disorder defined by an EF of less than 35% on a 99mTc-HIDA (CCK-HIDA) scan [ 6 ].…”