HIDA Scan with Ejection Fraction is over Utilized in the Management of Biliary Dyskinesia

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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Gallbladder Ejection Fraction Declines with Age in Patients Undergoing Cholecystectomy for Acalculous Biliary Symptoms But Has Low Accuracy in the Prediction of Gallbladder Pathology

Digestive Surgery ◽

10.1159/000371455 ◽

2015 ◽

Vol 32 (1) ◽

pp. 68-72 ◽

Cited By ~ 1

Author(s):

Aled Jones ◽

Golnaz Shahtahmassebi ◽

David Stell

Keyword(s):

Ejection Fraction ◽

Predictive Accuracy ◽

Normal Values ◽

Normal Population ◽

Iminodiacetic Acid ◽

Biliary Colic ◽

Roc Curve Analysis ◽

Chi Square ◽

Gallbladder Ejection Fraction ◽

Hida Scan

Background/Aims: Hepatobiliary Iminodiacetic Acid (HIDA) scan provides a technique to quantify gallbladder ejection fraction (EF) in patients suffering acalculous biliary colic (ACBC). We wished to evaluate the accuracy of EF in the prediction of gallbladder pathology in patients undergoing cholecystectomy. Methods: Data were retrieved from a database of patients referred for HIDA scan for ACBC, including EF and the pathological outcome of those undergoing cholecystectomy, and compared to normal values obtained from a review of related studies. Significant associations were demonstrated by chi-square, Mann-Whitney test, and linear regression. The predictive accuracy of different cut-offs of EF was demonstrated by the ROC curve analysis. Results: Of 83 patients referred for HIDA scan for ACBC, 41 underwent cholecystectomy. The median EF of this group (33%) was significantly lower than the composite normal median value from previous studies (56%). Thirty-two patients revealed evidence of gallbladder pathology. The EF declined with age (coefficient = -0.51, 95% CI = -0.99 to -0.33), but the median value did not differ between those with gallbladder pathology (34%) and those with normal gallbladders (29%). Conclusion/Discussion: Although an EF cut-off of 35% had the greatest accuracy in the prediction of pathology of those tested (0.56), the poor negative predictive value (23.5%) was a major contributor to its low accuracy. Although patients with ACBC have reduced gallbladder EF compared to the normal population, its quantitative assessment is of limited value in the prediction of gallbladder pathology.

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Diagnostic value of pre-operative upper GI endoscopy in gall bladder stone patients undergoing elective laparoscopic cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20193347 ◽

2019 ◽

Vol 6 (8) ◽

pp. 2949

Author(s):

Hiremath Chandrasekharaiah Srikantaiah ◽

Vinay Bhadrapura Manjappa

Keyword(s):

Laparoscopic Cholecystectomy ◽

Symptomatic Relief ◽

Diagnostic Value ◽

Biliary Colic ◽

Upper Gastrointestinal Endoscopy ◽

Confidence Levels ◽

Upper Gi ◽

Ultrasound Findings ◽

Upper Gi Endoscopy ◽

Upper Abdominal

Background: Cholecystectomy does not offer all symptomatic relief in most of the patients because of an overlap in the symptomology of biliary and gasroduodenal pathologies. Thus, we aimed at evaluating the efficacy of upper gastrointestinal endoscopy (UGE) in all patients with upper abdominal pain irrespective of ultrasound findings or symptoms.Methods: This prospective study was carried out from November 2015 – August 2017. Patients above 18 years, with ultrasonographically proven diagnosis of cholelithiasis, undergoing laparoscopic cholecystectomy by a single surgeon were studied. UGE was referred to all patients before surgery. Descriptive statistics was used to analyze pathological UGE findings and corresponding 95% confidence levels (CI) was calculated.Results: A total of 117 patients were included in this study with a mean age of 43.6±13.8 years. Majority of the patients were women (59.8%) and most of them presented atypical biliary colic symptoms (n=64, 54.7%). UGE of patients with biliary colic symptoms showed that 65.8% of patients had normal endoscopy findings when compared to 34.2% of patients had positive endoscopy findings. Significantly higher proportion patients with positive UGE findings presented atypical biliary (70%, n=28) when compared to typical biliary colic patients with positive findings (30%, n=12; p<0.05). Among patients being positive for UGE detected lesions, gastritis (~18%), followed by duodenal ulcer (10%) and reflux esophagitis (5%) were the common upper GI problems observed.Conclusions: Pre-elective and routine use of UGE before laparoscopic cholecystectomy helps in reducing persistence of symptoms and in treatment management.

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Pediatric Biliary Dyskinesia: Evaluating Predictive Factors for Successful Treatment of Biliary Dyskinesia with Laparoscopic Cholecystectomy

The American Surgeon ◽

10.1177/000313481808400939 ◽

2018 ◽

Vol 84 (9) ◽

pp. 1401-1405

Author(s):

Yamuna T. Krishna ◽

Kristine L. Griffin ◽

Robert L. Gates

Keyword(s):

Ejection Fraction ◽

Pediatric Patients ◽

Epigastric Pain ◽

Iminodiacetic Acid ◽

Biliary Dyskinesia ◽

Study Patient ◽

Duration Of Symptoms ◽

Symptom Resolution ◽

Persistent Symptoms ◽

Postoperative Symptom

Biliary dyskinesia (BD) is a motility disorder of the gallbladder that can result in right upper quadrant (RUQ) pain, nausea, vomiting, and diarrhea. Cholecystectomy is considered the standard of care for BD. Up to 23 per cent of pediatric patients who undergo surgery for BD have persistent symptoms postoperatively. We performed a retrospective review to identify preoperative factors significantly associated with symptom resolution after cholecystectomy. We retrospectively reviewed pediatric patients aged 10–17 years diagnosed with BD who underwent cholecystectomy between 2006 and 2016. Patients were divided into two groups based on postoperative symptom resolution. Chi-squared and student t tests were used to compare patient groups. Two hundred and thirty-six patients were included in the study. The most common preoperative symptoms included RUQ pain (80.1%), nausea (54.2%), postprandial pain (44.5%), vomiting (32.6%), and epigastric pain (19.9%). The rate of postoperative symptom resolution was 68.6 per cent. Comparative analysis showed patients who presented with RUQ pain, nausea, postprandial pain, or constipation experienced significantly higher rates of symptom resolution postoperatively. In addition, patients with ejection fraction <35 per cent or pain reproducible with cholecystokinin were found to have significantly higher rates of symptom resolution as well. To date, it remains difficult to predict successful outcomes for pediatric patients undergoing cholecystectomy for BD. In our study, patient demographics and duration of symptoms did not affect postoperative outcomes. Pediatric patients who presented with RUQ pain, nausea, postprandial pain, constipation, an ejection fraction of <35 per cent on hepatobiliary iminodiacetic acid, or pain reproducible with cholecystokinin injection, were found to have significantly higher rates of symptom resolution.

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Role of Cholecystectomy in Symptomatic Hyperkinetic Gallbladder Patients

Case Reports in Surgery ◽

10.1155/2021/5569850 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Jai P. Singh

Keyword(s):

Abdominal Pain ◽

Complete Resolution ◽

Biliary Colic ◽

Quadrant Pain ◽

Gallbladder Ejection Fraction ◽

Hida Scan ◽

Upper Abdominal ◽

The Right ◽

Upper Abdomen

Introduction. Biliary dyskinesia is defined by a gallbladder ejection fraction (EF) of less than 35% on HIDA scan, and these patients have shown a good response to cholecystectomy. Management of patients with biliary colic symptoms who have a hyperkinetic gallbladder ( EF > 80 % ) is not clearly defined. Herein, I report three cases of the symptomatic hyperkinetic gallbladder that were successfully managed with cholecystectomy. Case Report. Patient 1was a 56-year-old female presented with pain in the right upper abdomen for one month. Her workup was unremarkable except for the gallbladder EF of 86%. Patient 2 was a 33-year-old female with similar symptoms and workup with gallbladder EF of 97%. Patient 3 was a 20-year-old female with right upper abdominal pain and gallbladder EF of 91%. Patients 1 and 3 had the normal US, normal CT scan, and normal EGD. Patient 2 had normal US and CT but did not undergo EGD. All three patients underwent laparoscopic cholecystectomy and had complete resolution of their symptoms. Conclusion. The hyperkinetic gallbladder is a rare phenomenon, which can cause debilitating right upper quadrant pain. All three patients had an excellent response to cholecystectomy. Therefore, it is concluded that the patients with biliary colic and gallbladder EF of 80% or higher should be strongly considered for surgery.

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Recurrent Pyogenic Cholangitis: ‘Sump Syndrome’ following Choledochoduodenostomy

Tropical Doctor ◽

10.1177/004947559702700121 ◽

1997 ◽

Vol 27 (1) ◽

pp. 51-52 ◽

Cited By ~ 2

Author(s):

T F Toufeeq Khan ◽

Zaheer A Sherazi ◽

Suseela Muniandy ◽

Malik Mumtaz

Keyword(s):

Abdominal Pain ◽

Hospital Admissions ◽

Late Complication ◽

Iminodiacetic Acid ◽

Endoscopic Retrograde ◽

Percutaneous Access ◽

Intrahepatic Calculi ◽

Hida Scan ◽

Recurrent Pyogenic Cholangitis ◽

Upper Abdominal

An uncommon and late complication of side-to-side choledochoduodenostomy (CDD), the ‘sump syndrome’, developed in a patient 4 years after surgery. Recurrent right upper abdominal pain, fever with chills and rigors and latterly, mild jaundice made her seek repeated hospital admissions which were treated successfully with antibiotics. During the last admission, ultrasonography, endoscopic retrograde cholangiography (ERC), computerized scanning (CT) and hepatic iminodiacetic acid (HIDA) scan using Tc99m confirmed multiple intrahepatic calculi with proximal dilatation, debris in the distal blind segment and delayed excretion through the CDD. At surgery, the choledochoduodenostomy was taken down and a Rouxen-Y hepaticojejunostomy (RHJ) was fashioned after ductal clearance. The closed end of the Roux loop was placed subcutaneously for subsequent percutaneous access for cholangiography and removal of calculi. She is asymptomatic and well 28 months after surgery.

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Hyperkinetic Gallbladder: An Indication for Cholecystectomy?

The American Surgeon ◽

10.1177/000313481307900920 ◽

2013 ◽

Vol 79 (9) ◽

pp. 882-884 ◽

Cited By ~ 11

Author(s):

Erika B. Lindholm ◽

J. Brannon Alberty ◽

Faith Hansbourgh ◽

James R. Upp ◽

John Lopoo

Keyword(s):

Pediatric Patients ◽

Symptomatic Relief ◽

Iminodiacetic Acid ◽

Study Patient ◽

Biliary Colic ◽

Hida Scan ◽

Postoperative Symptoms ◽

Low Ejection Fraction ◽

Gallbladder Removal

Cholecystectomy may benefit children with biliary colic without stones on ultrasound (US) or low ejection fraction on cholecystokinin-hepatobiliary iminodiacetic acid (CCK-HIDA) scan. Children with symptomatic biliary colic and abnormal HIDA scan, specifically those with high ejection fractions, may benefit from cholecystectomy. All patients younger than 18 years old undergoing cholecystectomy from 2008 to 2012 in our practice were reviewed. Patients with a negative US and CCK-HIDA ejection fractions 80 per cent or greater were included in the study. Patient data were extracted from charts, whereas postoperative symptoms were obtained by phone interviews. Of 174 patients who underwent cholecystectomy, 12 (7%) met study criteria. All patients (12 of 12) had evidence of cholecystitis on the final pathology note. All 11 patients contacted had relief of colic after gallbladder removal with a mean follow-up of 16 months. A subset of pediatric patients with high ejection fractions on CCK-HIDA and symptomatic biliary colic may have symptomatic relief with cholecystectomy.

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

Minimally Invasive Surgery ◽

10.1155/2019/5705039 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Manuneethimaran Thiyagarajan ◽

Eniyan Kamaraj ◽

Nitesh Navrathan ◽

Mohanapriya Thyagarajan ◽

Balaji Singh Krishna

Keyword(s):

Laparoscopic Cholecystectomy ◽

Ejection Fraction ◽

Clinical History ◽

Accurate Method ◽

Hida Scan ◽

Large Size ◽

Diabetic Status ◽

Gallbladder Dyskinesia ◽

Detailed Clinical History

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.

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Optimal Management of the Hyperkinetic Gallbladder: A Comparison of Outcomes Between Operative and Nonoperative Approaches

The American Surgeon ◽

10.1177/0003134820966283 ◽

2020 ◽

pp. 000313482096628

Author(s):

Michael L. Williford ◽

Katherine T. Fay ◽

Francis J. Simpson ◽

Ann M. Defnet ◽

David M. Schuster ◽

...

Keyword(s):

Gallbladder Disease ◽

Iminodiacetic Acid ◽

Emergency Department Visits ◽

Symptom Improvement ◽

Optimal Management ◽

Hida Scan ◽

Symptom Profile ◽

Institutional Review ◽

Current Symptom ◽

Surgical History

Background A hyperkinetic gallbladder is defined as a hepatobiliary iminodiacetic acid (HIDA) scan ejection fraction (EF) of >80%. This condition is poorly described, and there is no current consensus on optimal management. The intent of this study was to determine if cholecystectomy improves symptoms in patients with a hyperkinetic gallbladder when compared to those managed nonoperatively and if there were variables predictive of symptom improvement with or without cholecystectomy. Materials and Methods This retrospective study included patients from 3 academic hospitals in the Atlanta metro area between the years 2006 and 2018. All patients with an EF >80% were included. Following voluntary exclusion patients were contacted by phone. Each patient was administered a questionnaire regarding their surgical history, medical management, and current symptom profile via Otago score. Institutional Institutional Review Board approval was obtained. Results 4785 HIDA scans were performed, and 194 reported an EF >80% (incidence 15.7%). 96% of these scans were reported as normal by the radiologist. 68 patients were able to be contacted by phone and completed the questionnaire. 18 patients underwent cholecystectomy, and 89% reported that their symptoms attributed to gallbladder disease were no longer present. 50 patients did not undergo cholecystectomy, and alternate diagnoses, medication prescriptions, diet modification, emergency department visits, and Otago score were higher in this cohort. Discussion Patients who undergo cholecystectomy for a diagnosis of hyperkinetic gallbladder, on average, report improvement in symptoms when compared to patients managed nonoperatively. This study supports the practice of reporting and managing hyperkinetic gallbladders as a pathologic entity.

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Cholecystectomy for Biliary Hyperkinesia

The American Surgeon ◽

10.1177/000313481908500232 ◽

2019 ◽

Vol 85 (2) ◽

pp. 219-222 ◽

Cited By ~ 2

Author(s):

Joshua Gazzetta ◽

Betty Fan ◽

Paul Bonner ◽

John Galante

Keyword(s):

Laparoscopic Cholecystectomy ◽

Chart Review ◽

Gallbladder Disease ◽

Retrospective Chart Review ◽

Biliary Colic ◽

Study Cohort ◽

Final Pathology ◽

Pathology Reports ◽

Histologic Changes

Patients with classic biliary colic symptoms and documented gallbladder ejection fractions on the higher end of the spectrum on hepatobiliary iminoacetic acid scans with cholecystokinin stimulation are presently understudied and the benefits of cholecystectomy are unclear. To determine whether patients with biliary-type pain and biliary hyperkinesia (defined as a gallbladder ejection fractions of 80% or greater) benefit from laparoscopic cholecystectomy, a retrospective chart review encompassing five community hospitals was performed. Patients 16 years and older with diagnosed biliary hyperkinesia who underwent laparoscopic cholecystectomy between January 1, 2010 and May 31, 2015 were included. Pathology reports were reviewed for histologic changes indicating cholecystitis. Resolution of biliary colic symptoms was reviewed one to three weeks after surgery in their postoperative follow-up documentation. Within our study cohort, we found 97 patients who underwent laparoscopic cholecystectomy for biliary hyperkinesia. Within this population, 84.5 per cent of patients undergoing laparoscopic cholecystectomy for biliary hyper-kinesia had positive findings for gallbladder disease on final pathology. Of the 77 patients with data available from their first postoperative visit, 70 (90.9%) reported improvement or resolution of symptoms. Our findings suggest that symptomatic biliary hyperkinesia may be treated successfully with surgery.

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Laparoscopic cholecystectomy during COVID-19 pandemic- Retrospective analysis of tertiary care centre

Nepal Mediciti Medical Journal ◽

10.3126/nmmj.v2i2.41282 ◽

2021 ◽

Vol 2 (2) ◽

pp. 82-86

Author(s):

Uttam Laudari ◽

Rosi Pradhan ◽

Dibesh Shrestha ◽

Bibek Timilsina ◽

Suhail Sapkota ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Retrospective Analysis ◽

Infection Prevention ◽

Open Cholecystectomy ◽

Gallbladder Disease ◽

Tertiary Care ◽

Infection Prevention And Control ◽

Biliary Colic ◽

Tertiary Care Centre ◽

Duration Of Hospitalization

INTRODUCTION: Laparoscopic cholecystectomy is the most commonly performed general surgical procedure. During the COVID-19 pandemic, general recommendation worldwide is to postpone elective surgeries as far as possible to decrease the resource utilization and also aerosol-related transmission among hospital staff and patients. We conducted this study to see the burden of gallbladder disease, their management and outcomes of all patients who presented to our centre during first wave of COVID-19 pandemic. METHODS: We conducted a retrospective analysis of all patients who underwent laparoscopic cholecystectomy at the Hospital for Advanced Medicine and Surgery (HAMS) after the commencement of strict lockdown in the first wave of the COVID-19 pandemic. Ethical approval for the study was taken from Nepal Health Research Council. All the surgeries were performed as per HAMS interim policy for infection prevention and control during the COVID-19 pandemic. Data were extracted from the discharge sheet and outcomes in terms of duration of hospitalization, morbidity, mortality, and COVID -19 infection among patient and operating team staff after surgery were assessed. RESULTS: Out of 110 cases operated for gallbladder disease, 90 patients were included in the study with complete data. The most common presentations were dyspepsia (28) and biliary colic (22). Patients were managed with laparoscopic cholecystectomy (79), percutaneous cholecystostomy (4), laparoscopic subtotal cholecystectomy (5), open cholecystectomy (1). The median duration of hospitalization 22 hours. There was no COVID-19 transmission among staff and patients. CONCLUSIONS: Laparoscopic cholecystectomies are feasible during COVID-19 pandemic and safely performed following infection prevention guidelines. It can be still be performed in day case basis to decrease the bed occupancy and avoiding crowd in hospitals.

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