LESS IS MORE WHEN IT COMES TO HEPATOBILIARY SCINTIGRAPHY FOR GALLBLADDER DYSKINESIA: MILKSHAKES SAVE HUNDREDS OF DOLLARS.
katelyn flick*1, Mazhar Soufi1, Christopher A. Sinsabaugh2, Mark Tann2, Cameron Colgate3, Michael G. House1
1General Surgery, Indiana University, Indianapolis, IN; 2Radiology, Indiana University, Indianapolis, IN; 3Statistics, Indiana University, Indianapolis, IN
Introduction
Since the advent of hepatobiliary scintigraphy (HIDA), controversy exists over its ability to assess functional gallbladder (GB) disease. HIDA has become a widely accepted method to diagnose GB dyskinesia, but supply shortages of cholecystokinin (CCK) have led to oral fatty meals as a stimulant for GB contraction during HIDA. The goal of this study was to compare the predictive measures of CCK and oral fatty meal stimulation of GB contraction.
Methods
Patients evaluated with HIDA from 2014-2017 were reviewed and grouped based on GB stimulant (oral fatty supplement v intravenous CCK) used during the study. Patients who later underwent cholecystectomy were selected for analysis. Ejection fraction (EF) percentages below 35% and above 80% were considered abnormal for GB function. HIDA results were correlated with surgical histopathology and postoperative resolution of symptoms to evaluate predictive metrics of HIDA relative to GB stimulant. Two-way statistical analysis was performed.
Results
A total of 451 patients underwent HIDA scan followed by cholecystectomy. Patients who received oral fatty supplementation (N=109, 24%) were compared to 342 (76%) patients who received intravenous CCK during HIDA imaging. Biliary dyskinesia as the indication for cholecystectomy was confirmed, and symptomatic improvement postoperatively was addressed during clinical follow-up visits. Sensitivity, specificity, negative and positive predictive value for HIDA test with CCK were: 76%, 22%, 87% and 11%, respectively. Corresponding values for oral fatty supplement were: 64%, 54%, 92%, and 15%, respectively. The accuracy of the two methods was comparable: 69% with CCK injection vs 63% for oral fatty supplement.
Conclusion:
Induction of gallbladder contractility with an oral fatty milkshake during HIDA imaging is a cheap and reliable alternative to CCK injection for patients undergoing evaluation for gallbladder dysmotility.
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