Effect of Physiologic CCK Administration in HIDA Results

James B Depew, MD, Gage Ochsner, MD, FACS

Memorial Health University Medical Center, Mercer University School of Medicine

Introduction: Biliary dyskinesia, or dysfunctional gallbladder bile ejection, can be measured through the use of a cholescintigraphy (HIDA) scan. A reduced ejection fraction (EF) of <35% suggests that cholecystectomy will result in symptom relief in the setting of acalculous cholecystitis. It has been proposed that a more physiologic 30-minute infusion of CCK to stimulate gallbladder ejection is a better predictor of normal gallbladder function over the previous 3-5 minute rapid infusion protocol. Memorial University Medical Center moved to this new protocol in Sept 2006.

Methods: A retrospective study was conducted in all patients who underwent a HIDA scan with EF for any reason at our 550-bed teaching hospital over the 26-month period surrounding the new CCK protocol. Multiple independent variables were collected on each patient including demographics, abdominal ultrasound results, cholecystectomy status, pathology reports, and biliary ejection fraction. To evaluate symptom resolution, a satisfaction survey was conducted in patients who subsequently underwent cholecystectomy.

Results: A total of 793 HIDA scans were completed with 342 of those having a concomitant normal ultrasound. The diagnosis of biliary dyskinesia was significantly higher at 53% in the 3-5 minute rapid infusion protocol versus 28% in the more physiologic 30-minute protocol. A similar portion of patients underwent cholecystectomy in each group with no difference in pathologic confirmation of acalculous cholecystitis. Satisfaction survey response rate was 65%. A greater portion of patients diagnosed with biliary dyskinesia by 30-minute infusion HIDA scan reported complete resolution of their presenting RUQ symptoms after cholecystectomy.

Conclusion: The more physiologic 30-minute infusion of CCK during HIDA scan may more reliably predict both biliary dyskinesia in acalculous cholecystitis and the potential for symptom resolution following cholecystectomy in this patient population.

Session: Podium Presentation

Program Number: S119