Clinical application of the cholecystokinin provocation test

Abstract

This paper reviews the value of administration of cholecystokinin (CCK) in the assessment of patients thought to have acalculous biliary pain. The literature contains conflicting reports and there is no unequivocal evidence to support the use of CCK provocation tests as a basis for deciding the need for cholecystectomy.

Efficacy of laparoscopic cholecystectomy in the pediatric population

“…These numbers are often used as a tool for the diagnosis of biliary dyskinesia, but Patel et al [19] noted that patients with EFs considered "normal" may also benefit from surgical intervention. These results have been reproduced throughout the adult and pediatric literature [4,[20][21][22][23].…”

The Cholecystokin Provocation HIDA Test: Recreation of Symptoms is Superior to Ejection Fraction in Predicting Medium-Term Outcomes

“…The CCK provocation test without a concomitant HIDA scan which involved infusion of CCK and assessment of symptom recreation was widely used prior to the widespread availability of HIDA. However, despite a large placebo-controlled crossover study with long-term follow-up supporting its use, 46 the literature, in a similar manner as it now is for CCK HIDA, was conflicting 38,47 and it was superseded by CCK HIDA. It was claimed that there was both subject and assessor bias and that the CCK would be stimulating organs other than the gallbladder and thus it was uncertain whether there was true symptom recreation.…”

Decision-making patterns in managing children with suspected biliary dyskinesia

“…It is generally recommended that hepatic function panel (AST, ALT, serum total and direct bilirubin, alkaline phosphatase) amylase/lipase, and an abdominal ultrasound be performed first to exclude hepatobiliary and pancreatic disorders[12,13]. Since these tests were already ordered and reported as normal in the clinical vignette, CCK-CS and an upper endoscopy were observed to be the most common tests chosen by respondents.…”