Cholecystokinin-Cholescintigraphy in Adults: Consensus Recommendations of an Interdisciplinary Panel

DiBaise, John K.; Richmond, Bryan K.; Ziessman, Harvey H.; Everson, Gregory T.; Fanelli, Robert D.; Maurer, Alan H.; Ouyang, Ann; Shamamian, Peter; Simons, Richard J.; Wall, Laura A.; Weida, Thomas J.; Tülchinsky, Mark

doi:10.1016/j.cgh.2011.02.013

Cited by 55 publications

(42 citation statements)

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“…Eligibility for enrollment was limited to patients 18 years of age and older with a normal gallbladder ultrasound, symptoms compatible with gallbladder dyskinesia as defined by the Rome III criteria 9 , and a CCK-HIDA scan with a GBEF of <38% that was performed using updated Society of Nuclear Medicine (SNM) guidelines for test administration and GBEF calculation 10,11 . Specifically, this consisted of a weight-based infusion of cholecystokinin (CCK, 0.02 mcg/kg) infused over one hour, with the GBEF calculated at the one hour mark 10,11 . Patients were excluded from enrollment if they had chronic abdominal pain from a secondary diagnosis (such as Crohn’s disease, peptic ulcer disease, or pain responsive to antacid/anti-secretory therapy), a history of allergy to amitriptyline or any comorbid condition that contraindicated its usage, or atypical symptoms not consistent with that described by the Rome III criteria.…”

Section: Patient Population and Methodsmentioning

confidence: 99%

Pilot Randomized Controlled Trial of Laparoscopic Cholecystectomy vs Active Nonoperative Therapy for the Treatment of Biliary Dyskinesia

Richmond

Grodman

Walker

et al. 2016

Journal of the American College of Surgeons

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Introduction Despite widespread adoption by the surgical community, high-quality prospective data supporting the practice of laparoscopic cholecystectomy (LC) for the treatment of biliary dyskinesia (BD) is lacking. Methods Adult patients meeting criteria for diagnosis of BD (Rome III symptoms, normal ultrasound, gallbladder ejection fraction<38%) were randomized to either LC or a trial of non-operative (NO) therapy with a low-dose neuromodulator (amitriptyline 25mg/day). Patients in the NO arm were allowed to cross over to the surgical arm and remain in the study for any reason. Besides collection of basic demographics and medical/surgical history, patients were administered a standardized quality of life (QOL) assessment (SF-8) and a symptom-specific questionnaire (Rome III criteria) at enrollment and monthly through the study to assess the effect of treatment on biliary symptoms and overall QOL. Results Thirty patients were enrolled over 12 months (15LC, 15NO). In the LC group, 13 underwent LC, 1 refused surgery, 1 withdrew. In the NO group, 14 crossed over to the LC group (of which 13 had LC), yielding 26 patients who underwent LC. SF-8 physical scores (PCS-8) were significantly improved at both the first and last follow-up visits (p<0.0001, p=0.0003 respectively). SF-8 mental scores (MCS-8) were also significantly improved at both the first and last follow-up visits (p=0.0187, p=0.0017 respectively). With median follow-up of 12 months [range 3–14], all 26 reported relief of pain. Conclusions This pilot study raises doubts regarding the feasibility of a randomized trial, presumably due to both clinician and patient bias toward LC and the lack of “gold-standard” non-operative treatments. However, these prospective data indicate that, with careful patient selection (standardized symptom criteria/imaging methodology), LC results in pain relief and significant improvement in QOL in BD patients. Further prospective study of these findings is warranted.

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Section: Patient Population and Methodsmentioning

confidence: 99%

Pilot Randomized Controlled Trial of Laparoscopic Cholecystectomy vs Active Nonoperative Therapy for the Treatment of Biliary Dyskinesia

Richmond

Grodman

Walker

et al. 2016

Journal of the American College of Surgeons

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“…Recent publication of the recommenda tions by the Society of Nuclear Medicine for the performance of cholecystokinin chole scintigraphy must be welcomed [5]. These recommendations represent a reasonable at tempt to standardize cholescintigraphy.…”

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confidence: 97%

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O’Connor¹,

Maher²

2012

American Journal of Roentgenology

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“…An expert panel of gastroenterologists, surgeons, and nuclear medicine physicians subsequently met and published a consensus report in both the gastroenterology literature and the nuclear medicine literature (53,54). The panel recommended that the 60-min method for infusing sincalide described in the multicenter trial should become the standard, specifically, 0.02 mg/kg infused at a constant rate via an infusion pump or slow drip over 60 min, with imaging and quantification over the entire 60-min period.…”

Section: Reference Values For Gbefmentioning

confidence: 99%

Hepatobiliary Scintigraphy in 2014

Ziessman

2014

J Nucl Med

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CE Credit: For CE credit, you can access the test for this article, as well as additional JNMT CE tests, online at https://www.snmmilearningcenter.org. Complete the test online no later than December 2017. Your online test will be scored immediately. You may make 3 attempts to pass the test and must answer 80% of the questions correctly to receive 1.0 CEH (Continuing Education Hour) credit. SNMMI members will have their CEH credit added to their VOICE transcript automatically; nonmembers will be able to print out a CE certificate upon successfully completing the test. The online test is free to SNMMI members; nonmembers must pay $15.00 by credit card when logging onto the website to take the test. Participants who have already taken the exam using JNM and passed cannot retake the exam.Cholescintigraphy with 99m Tc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to be in much clinical demand; however, the indications, methodology, and interpretative criteria have evolved over the years. This review will emphasize state-of-the-art methodology and diagnostic criteria for various clinical indications, including acute cholecystitis, chronic acalculous gallbladder disease, high-grade and partial biliary obstruction, and the postcholecystectomy pain syndrome, including sphincter-of-Oddi dysfunction and biliary atresia. The review will also emphasize the use of diagnostic pharmacologic interventions, particularly sincalide. Now almost 4 decades old, 99m Tc cholescintigraphy continues to be a radionuclide imaging study in much clinical demand. Its strength lies in the fact that the diagnostic information provided defines pathophysiology rather than anatomy.123 I-and 123 I-rose bengal were the first clinically useful cholescintigraphic agents; however, image quality was relatively poor (Fig. 1). 99m Tc-hepatobiliary radiopharmaceuticals began to be widely used by the early 1980s.The discovery of 99m Tc-hepatobiliary (HIDA) radiopharmaceuticals was by chance. During investigation for a cardiac imaging radiopharmaceutical, it was found that 99m Tclabeled lidocaine was not a good cardiac imaging agent but cleared through the hepatobiliary system. With chemical modification, 99m Tc-HIDA imaging agents were born. Loberg et al. reported on this in 1976 (1). Its structure is simply that of 2 lidocaine analogs bichelated to 99m Tc by iminodiacetic acid (IDA) (Fig. 2). HIDA (hepatoiminodiacetic acid) has long been used as a generic term for cholescintigraphy.Modifications of the benzene ring of the lidocaine analogs resulted in an alphabet soup of hepatobiliary radiopharmaceuticals (PIPIDA, BIDA, EIDA, DIDA, DISIDA, etc.), each with different rates of hepatic uptake and clearance. The first 99m Tc-HIDA radiopharmaceutical was approved for clinical use by the Food and Drug Administration in 1982. Dimethyl IDA (lidofenin [Technescan; Mallinckrodt]) was a major advance, but image quality and diagnostic utility were suboptimal in patients with seru...

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Cholecystokinin-Cholescintigraphy in Adults: Consensus Recommendations of an Interdisciplinary Panel

Cited by 55 publications

References 47 publications

Pilot Randomized Controlled Trial of Laparoscopic Cholecystectomy vs Active Nonoperative Therapy for the Treatment of Biliary Dyskinesia

Pilot Randomized Controlled Trial of Laparoscopic Cholecystectomy vs Active Nonoperative Therapy for the Treatment of Biliary Dyskinesia

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Hepatobiliary Scintigraphy in 2014

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