Quantitative cholescintigraphy with fatty meal in the diagnosis of Sphincter of Oddi dysfunction and acalculous cholecystopathy

Abstract

To evaluate the role of quantitative cholescintigraphy with fatty meal in the management of biliary dyskinesia and to describe the findings according to Sostre score (SS) criteria in patients with gallbladder (GB) in-situ and biliary pain. We performed a retrospective analysis of the hepatobiliary (HIDA) studies (n = 35) performed for evaluation of biliary dyskinesia either due to biliary pain, opioid induced sphincter of Oddi dysfunction (SOD), recurrent pancreatitis (RP) or post cholecystectomy syndrome (PCS). Gallbladder ejection fraction (GBEF) was calculated from the post fatty meal HIDA images (excluding PCS patients). Studies with GBEF ≤40 % and SS >4 were considered to have cholecystopathy and SOD respectively. Three of the 13 patients with PCS had SS of 6 each, suggestive of SOD. Delayed biliary visualization (>15 min) and activity in common bile duct 60 min > liver 15 min were the specific features in these cases. Opioid induced SOD patients had SS >4 with retrograde refilling of GB in one patient and normalization of the SS parameters after nifedipine challenge in the other patient. Patients with RP and biliary pain were stratified into four groups, normal (GBEF >40 % and SS ≤4), cholecystopathy (GBEF ≤40 % and SS ≤4), normal with SOD (GBEF >40 % and SS >4) and cholecystopathy with SOD (GBEF ≤40 % and SS >4). Four patients with intact GB had cholecystopathy with scintigraphic features of SOD. Quantitative cholescintigraphy with fatty meal and SS scoring identified biliary dyskinesia and SOD in patients with biliary pain, recurrent pancreatitis and post-cholecystectomy syndrome.

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

“…Several previous studies have also retrospectively assessed the utility of fatty meal cholescintigraphy in functional gallbladder disorder using custom fatty meal formulations 8–10 . The largest study was by Al Muqbel et al 8 .…”

“…7 Several previous studies have also retrospectively assessed the utility of fatty meal cholescintigraphy in functional gallbladder disorder using custom fatty meal formulations. [8][9][10] The largest study was by Al Muqbel et al 8 in 2009 which retrospectively assessed 198 patients. They used a fatty meal formulation composed of chocolate and yogurt with an abnormal GBEF defined as ≤50% based on their institutional experience.…”

Sphincter of Oddi Function and Risk Factors for Dysfunction

“…This includes calcium-channel blockers ( 103 , 104 ), tricyclic antidepressants ( 105 ), Botox ® , glyceryl trinitrate (GTN), and somatostatin. Nifedipine has been shown to reverse opiate-induced effects on the SO ( 106 ) and improve pain associated with SOD in a short-term study ( 103 ). Injection of Botox ® into the SO via sclerotherapy needle reduced sphincter pressure by 50% for 4 months and was followed by 50% improvement in bile flow in two patients with postcholecystectomy pain and elevated SO pressures ( 107 ).…”

Epidemiology, diagnosis and management of patients with biliary dyskinesia and sphincter of Oddi dysfunction: a survey of Indian gastroenterologists

“…3 In patients with suspected biliary pain, quantitative cholescintigraphy and Sostre score criteria can help diagnose BD and SOD. 4 Manometry is most important diagnostic method for SOD. 5 However, there are diagnostic challenges especially in resource limited settings.…”