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2001 Abstract: 2397 Kinevac Stimulated Ultrasound Correlated with Biliary Manometry and Clinical Outcome in Patients with Chronic Acalculous Cholecystitis

2001 Digestive Disease Week

# 2397 Kinevac Stimulated Ultrasound Correlated with Biliary Manometry and Clinical Outcome in Patients with Chronic Acalculous Cholecystitis
David J. Soto, Maurice E. Arregui, Indianapolis, IN

Most carefully selected patients with biliary-type symptoms and acalculous gallbladders have improvement or resolution of symptoms after cholecystectomy. The decision to operate is often dependent on the clinical symptoms and gallbladder ejection fraction (GBEF) as determined by a Kinevac (cholecystokinin) stimulated HIDA scan. The purpose of this study is to evaluate the utility of Kinevac stimulated ultrasound (US) of the gallbladder (GB) and common hepatic duct (CHD) in patients with chronic acalculous cholecystitis (CAC). Thirty-one consecutive patients with clinical symptoms of CAC underwent laparoscopic cholecystectomy with attempted transcystic biliary manometry of the sphincter of Oddi (SO). The SO was considered hypertensive if a basal pressure greater than 40 mm HG was sustained. Patients were evaluated preoperatively with a Kinevac stimulated HIDA scan of the GB and a Kinevac stimulated US of the GB and CHD. A GBEF of £35% was considered abnormal. The CHD was considered to respond abnormally if it increased in diameter within 1, 5, 10 or 15 minutes after infusion of Kinevac (0.04 mg/kg over 1 minute). The results of the Kinevac stimulated US and HIDA scans were compared independently to the SO manometry findings, gallbladder pathology and clinical outcome using Kappa coefficient correlation. Two patients were lost to follow-up; Kinevac stimulated US was not performed in 4 patients; and manometry was unable to be performed in 5 patients. Eighty-three percent of patients were found to have a hypertensive SO. Seventy-six percent of patients had resolution (12) or improvement (10) of symptoms and 7 patients had persistence of symptoms. All gallbladers demonstrated pathologic findings of chronic cholecystitis. GBEF determined by Kinevac stimulated US had a 50% sensitivity and a 55% specificity in predicting improvement or resolution of symptoms. Response of the CHD to Kinevac as measured by US had a 33% sensitivity and a 12% specificity. HIDA scan had a 72% sensitivity and a 38% specificity. Biliary manometry had an 88% sensitivity and a 33% specificity. HIDA scan and Kinevac US correlated poorly with manometric findings (kappa £ 0.030). Kinevac stimulated HIDA scan and US are no better than clinical judgement of symptoms in predicting which patients with acalculous biliary-type symptoms will improve after cholecystectomy. The incidence of SO hypertension was high in this patient population suggesting it to be a contributing factor in the etiology of CAC.

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