Clinical utility of stimulated cholescintigraphy using a standardized Ensure‐Plus fatty meal protocol in patients with suspected functional gallbladder disorder: a retrospective study of seven‐years clinical experience

Abstract

Background The clinical utility of fatty meal stimulated cholescintigraphy particularly using a standardized formulation in patients with suspected functional gallbladder disorder has not been extensively studied. We present our seven‐year clinical experience using an Ensure plus protocol. Methods A retrospective study was performed on patients undergoing stimulated cholescintigraphy using Ensure Plus for evaluation of suspected functional gallbladder disorder. A gallbladder ejection fraction (GBEF) of <33% was considered abnormal. Results Of the 173 patients evaluated, 57 (33%) had an abnormal GBEF, 112 (65%) had a normal GBEF and 4 (2%) had no gallbladder visualization. Of the 57 patients with an abnormal GBEF, symptom improvement occurred in 30/31 (97%) who underwent cholecystectomy and in 17/26 (65%) who were managed conservatively (p = 0.003). Of the 112 patients with a normal GBEF, symptom improvement occurred in 8/10 (80%) who underwent cholecystectomy and 74/102 (73%) who were managed conservatively (p = 1.000). In the subgroup of 102 patients with a normal GBEF managed conservatively, those without symptomatic improvement had lower GBEFs compared to those with symptomatic improvement (median GBEF 46% versus 57%, p = 0.019). Conclusion Our retrospective results support a clinical role for stimulated cholescintigraphy using Ensure Plus in the evaluation of patients with suspected functional gallbladder disorder. While an abnormal GBEF predicts good surgical outcome, our results suggest that using an absolute GBEF cut off value of <33% may not apply to all patients and hence GBEF results should only be used as an adjunct in the surgical decision‐making process.

Use of a Fatty Meal Cholecystagogue Protocol in Hepatobiliary Scintigraphy for Chronic Functional Gallbladder Disease

“…Initial work on gallbladder contraction and biliary excretion resulted from cholegraphic studies in which patients were administered an oral cholecystagogue (22)(23)(24)(25). Examples of the reported oral cholecystagogues include milk, corn oil emulsion, Cholex (egg yolk, soya lecithin, glycerin, and peanut oil), D-sorbitol solution, safflower oil emulsion, vegetable oil, fatty meal (Lipomul), and Ensure Plus (5,8,12,22,23,(25)(26)(27)(28)(29)(30)(31)(32)(33). In 1957, cholecystokinin was developed as an intravenous cholecystagogue demonstrating prompt and strong contraction of the gallbladder and opening of the sphincter of Oddi (2,3).…”

“…The descriptive statistics from that same study found that the sensitivity, specificity, positive predictive value, and negative predictive value for chronic cholecystitis on histopathology or for a subjective reduction in postoperative biliary-type pain in patients undergoing cholecystectomy. Li et al assessed the symptoms for patients undergoing hepatobiliary scintigraphy with Ensure Plus for suspected chronic functional gallbladder disorder, comparing the symptom outcomes after cholecystectomy or conservative management in patients with normal or abnormal gallbladder ejection fractions (27). In patients with abnormal gallbladder ejection fractions on Ensure Plus hepatobiliary scintigraphy, 97% experienced symptom improvement after cholecystectomy, compared with 65% who were treated conservatively.…”

Fatty Meal Hepatobiliary Scintigraphy for Gallbladder Ejection Fraction Determination

“…Historically, cholecystokinin analogs such as sincalide have been used; however, because these analogs are often subject to supply shortages, alternative cholecystagogues have been evaluated (4,5). A well-studied oral cholecystagogue is Ensure Plus (Abbott Laboratories), a liquid fatty meal (6)(7)(8). Ensure Plus is readily available, inexpensive, and effective in assessing gallbladder ejection fraction.…”