Introduction Gallbladder ejection fraction (GBEF) from sincalide cholescintigraphy is frequently used as an index for referring patients with gallbladder dyskinesia for cholecystectomy. Many studies have reported the cut-off point used (GBEF ≤35%) to be arbitrary and a significant number of patients who undergo cholecystectomy on this criteria remain symptomatic even after surgery. The aim of this study is to examine alternative parameters for quantification of hepatobiliary scintigraphy.
Methods 81 patients who were investigated with sincalide cholescintigraphy (including GBEFmax estimation) were reviewed at 6–18 months. GBEF at 10 min (GBEF10), peak emptying rate, time to peak emptying rate and area under the curve (AUC) were calculated. These parameters were compared between the groups of patients remaining symptomatic and asymptomatic post-operatively and in those who did not undergo surgery. Student t test was used to compare group means.
Results 40/81 patients had abnormal GBEFmax (≤35%). 31/40 patients underwent laproscopic cholecystectomy along with 10/41 patients with a normal GBEFmax. 12/41 patients (29%) remained symptomatic post-operatively. There were significant differences between symptomatic and asymptomatic patients of the surgery group for GBEF10 (13% vs 22%, p=0.03), peak emptying rate (−0.03 cpm2 vs −0.05 cpm2, p=0.01) and AUC (0.88 counts vs 0.81 counts. p=0.047). These parameters were more “normal” in those patients who benefited from surgery. No significant differences were found between symptomatic and asymptomatic patients from the non-surgery group or patients with normal vs abnormal histology.
Conclusion Patients who remain symptomatic after laparoscopic cholecystectomy for gall bladder dyskinesia have more abnormal values in the above mentioned alternative parameters implying an inherent abnormality in biliary tract function. Hence we propose that these parameters may be useful to identify patients with gall bladder dyskinesia who will benefit from cholecystectomy.
Competing interests None declared.
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