ReviewCholecystokinin-Cholescintigraphy in Adults: Consensus Recommendations of an Interdisciplinary Panel
Section snippets
Normal and Abnormal Gallbladder Function and Clinical Correlation
The gallbladder and biliary tract play an important role in the controlled delivery of bile into the duodenum. The gallbladder stores and concentrates bile during the fasting state, supported by the function of the sphincter of Oddi, which maintains the pressure in the common bile duct higher than that in the duodenum or the gallbladder. The gallbladder empties mainly postprandially due to the coordinated contraction of the gallbladder and simultaneous relaxation of the sphincter of Oddi. Both
Validation of Proposed CCK-Cholescintigraphy Protocol
Previously published investigations have reported that longer infusions of sincalide result in less variable GBEF in healthy individuals; however, many different methods are in common use. Furthermore, sufficient published data have shown that a 3-minute infusion, a method that appears to be commonly used in clinical practice, exhibits considerable variability and unpredictability in normal subjects and commonly produces side effects of abdominal cramping and nausea. The Gastrointestinal
Clinical Role of CCK-Cholescintigraphy
At present, CCK-CS with measurement of the GBEF is the most commonly ordered test in the United States for determining gallbladder contraction. The following potential indications were discussed by the members of the interdisciplinary panel, although high quality clinical trials using this proposed standardized method are needed to assess the clinical utility of CCK-CS in these settings.
1. Functional Gallbladder Disorder
To date, Yap and colleagues have published the only randomized controlled study of cholecystectomy based on GBEF in FGBD.37 They studied 21 patients with suspected functional biliary pain and a GBEF <40% based on a 45-minute infusion of CCK. Eleven patients were randomized to cholecystectomy and 10 to no surgery. Over a 3-year period, 10 patients became asymptomatic after cholecystectomy and 1 reported improved symptoms after surgery. In contrast, the majority of the patients in the no surgery
Summary of Recommendations
The panel recommends use of a single, standardized CCK-CS protocol in adults that uses infusion of 0.02 μg/kg of sincalide over 60 minutes, with a normal GBEF being defined as ≥38%.30 The consensus panel did consider how the longer imaging time might affect the workflow of camera use in imaging centers and the potential reluctance to adopt this protocol due to concerns that reimbursement may not be commensurate with the time and effort needed, and possible methods to shorten the methodology.
References (57)
Cholecystokinin cholecystography
Sem Roetgenology
(1976)- et al.
Biliary pain in young women in the absence of gallstones
Gastroenterology
(1971) - et al.
Gallbladder emptying in response to cholecystokininA cholescintigraphic study
Gastroenterology
(1979) - et al.
Radionuclide ejection fraction: a technique for quantitative analysis of motor function of the human gallbladder
Gastroenterology
(1981) - et al.
Does gallbladder ejection fraction predict outcome after cholecystectomy for suspected chronic acalculous gallbladder dysfunction? A systematic review
Am J Gastroenterol
(2003) - et al.
Functional gallbladder and sphincter of Oddi disorders
Gastroenterology
(2006) Cholecystokinin cholescintigraphy: clinical indications and proper methodology
Radiol Clin North Am
(2001)Functional hepatobiliary disease: chronic acalculous gallbladder and chronic acalculous biliary disease
Semin Nucl Med
(2006)- et al.
Acalculous biliary pain: cholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy
Gastroenterology
(1991) - et al.
What symptoms does cholecystectomy cure?Insights from an outcome measurement project and review of literature
Am J Surg
(1995)
Natural history of asymptomatic and symptomatic gallstones
Am J Surg
Abnormal gallbladder emptying in a subgroup of patients with gallstones
Gastroenterology
Gallstone disease: surgical aspects of symptomatic cholecystolithiasis and acute cholecystitis
Best Pract Res Clin Gastroenterol
Risk assessment in cholelithiasis: is cholecystectomy always to be preferred?
J Gastrointest Surg
Serial cholecystographyA means of preoperative diagnosis of biliary dyskinesia
AMA Arch Surg
The cystic duct syndrome
JAMA
Experiments with cholecystokinin
Acta Radiol
Cholecystokinin cholecystography
JAMA
Cholecystokinin cholecystography
Radiology
Gallbladder ejection fraction: correlation of scintigraphic and ultrasonographic techniques
Clin Nucl Med
Comparison of sonography and scintigraphy in the evaluation of gallbladder functional studies with cholecystokinin
J Ultrasound Med
Three-dimensional sonographic evaluation of gallbladder contractility: comparison with cholescintigraphy
J Clin Ultrasound
Gallbladder emptying in normal subjects – a database for clinical cholescintigraphy
Gut
Reproducibility of gallbladder emptying scintigraphic studies
J Nucl Med
Cholecystokinin cholescintigraphy: methodology and normal values using a lactose-free fatty-meal food supplement
J Nucl Med
Corn oil emulsion: a simple cholecystogogue for diagnosis of chronic acalculous cholecystitis
J Nucl Med
Prevalence of gallbladder dyskinesia in gastroparesis
Am J Gastroenterol
Gallbladder and sphincter of Oddi disorders
Am J Gastroenterol
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2020, Surgery (United States)Citation Excerpt :The Rome Criteria for biliary pain and functional gallbladder disorders specifies pain lasting at least 30 minutes and associations with nausea, vomiting, and radiation, etc.12,14 The Rome Criteria, however, have not been evaluated in relation to gallbladder hyperkinesia, because an entity of gallbladder hyperkinesia is not as yet formally recognized.12,14 For instance, diarrhea and postprandial exacerbation of symptoms—seen in close to 40% and 80% of patients in our study, respectively—are not listed in the Rome Criteria.12,14 Some of the gallbladder hyperkinesia case series draw a link between CCK provocation during a HIDA scan and reproduction of symptoms.16–18
Gallbladder Ejection Fraction
2018, Journal of the American College of SurgeonsGallbladder Ejection Fraction and Biliary Scintigraphy: In Reply to Richmond and Fanelli
2018, Journal of the American College of SurgeonsGallbladder disease in children
2016, Seminars in Pediatric Surgery
Conflicts of interest The authors disclose the following: Mark Tulchinsky has the following relationship with Bracco Diagnostics Inc: (1) consultant, (2) speaker at company supported lectures, and (3) investigator on company sponsored/supported studies. The remaining authors disclose no conflicts.
Funding Financial support for the meeting of the interdisciplinary panel that led to the development of the manuscript was received from Bracco Diagnostics Inc, in the form of an unconditional grant. Bracco Diagnostics Inc did not contribute to or influence the development of the manuscript.