HIDA scan ejection fraction does not predict sphincter of Oddi hypertension or clinical outcome in patients with suspected chronic acalculous cholecystitis

Abstract

Although the PPV of abnormal HIDA EF is high, it is not much better than the clinical impression. The sensitivity and specificity are marginal. The NPV is poor. Based on the review of these 93 patients, HIDA EF is not reliable for identifying CAC. We recommend that patients with normal HIDA EF have additional testing or consultation before ruling out CAC. HIDA EF does not predict SOH.

Systematic review with meta‐analysis: cholecystectomy for biliary dyskinesia—what can the gallbladder ejection fraction tell us?

“…One hundred four studies were further excluded on initial review with reasons for exclusion noted. Forty‐six studies were included; a further 17 were excluded due to lack of a matching comparator group; 29 were included in the final quantitative analysis (Table and Figure ) …”

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

“…While there is significant data in support of the use of EF in predicting outcome in patients with biliary dyskinesia, 10, there is also a sizeable volume of literature reporting the contrary [33][34][35][36][37][38][39][40][41][42][43][44][45] and thus there is need for some form of modification to the investigation to improve the diagnostic accuracy.…”

“…43 It is uncertain as to the relationship between biliary dyskinesia and the presence of calculi or cholesterolosis. Velanovich 50 examined the bile of patients with an EF of <35%, comparing it to the bile of patients with known gallstones and noted the presence of crystals in the bile or gallbladder wall, with no difference between the groups.…”

“…11 Despite a body of evidence in support of CCK HIDA, 10,12-32 a number of authors have claimed that the EF is poor in predicting symptomatic outcome following cholecystectomy. [33][34][35][36][37][38][39][40][41][42][43][44][45] In addition to the variation in dose and administration, many of the current studies are of poor methodology and there is currently only one randomised controlled trial addressing this topic.…”

ERCP in acute and recurrent acute pancreatitis

“…Since the yield is probably <20%, diagnostic ERCP is no longer recommended in the absence of SOM [38,49,50]. Secretin-enhanced MRCP and EUS and other noninvasive functional tests do not consistently correlate with the results of SOM; therefore, their role in the diagnostic algorithm for patients with idiopathic RAP requires further investigation [51][52][53][54][55]. That said, the implications of diagnosing an RAP patient with sphincter of Oddi dysfunction remain uncertain.…”