N. A. Markwith1, J. A. Taylor1, S. D. Larson1, D. Solomon1, W. Drane1, S. Islam1 1University Of Florida,Pediatric Surgery,Gainesville, FL, USA
Purpose: Clinicians have used the cholecystokinin stimulated HIDA scan (CCK-HIDA) to evaluate patients with abdominal pain since 1976. The test is used to identify patients who have symptoms caused by biliary dyskinesia, and help select those who would respond to a cholecystectomy. While the incidence of cholecystectomy for biliary dyskinesia has rapidly risen in children in the past decade, the appropriate use of the CCK-HIDA scan remains controversial. The purpose of this study was to better understand the utility of this test in a cohort of children with abdominal pain.
Methods: Children who underwent a CCK-HIDA scan over a 15 year period were included in the study. Inclusion criteria were scans performed for evaluation of abdominal symptoms, therefore infants, patients after a liver transplant, or for evaluation of other conditions were excluded. Relevant clinical data including symptoms, duration, demographics, results of other labs and imaging, HIDA results, and outcomes including any procedures were abstracted from the clinical records and analyzed. Uni- and multivariate analysis was performed and a p value of less than 0.05 was considered significant.
Results: A total of 190 patients met the inclusion criteria. Mean age was 14.4 years, 74.5% were female and 47% Caucasian. 47.3% were either overweight or obese, and 73.2% presented with right upper quadrant or epigastric pain. Overall, the mean ejection fraction (EF) was 59.5%, with 23.2% less than 35% EF. Comparison of patients with an EF less than 35% and greater than 36% is shown in the Table. Restricting to cholecystectomy, adoption of a stringent EF <20% as criteria, only 53% had surgery, with 50 % long term resolution (partial or complete), compared to overall resolution of symptoms in 48.4% patients. When analyzed using multivariate regression with 'any symptom resolution' as a binary outcome variable, neither EF nor pain reproduction on CCK administration could predict outcome.
Conclusions: These data suggest that the CCK-HIDA scan cannot adequately select patients who would benefit from a cholecystectomy, even with very low EF. Adoption of better criteria to perform the study would be beneficial and result in substantial cost saving during the work up of abdominal pain. Prospective large studies would help in understanding the role of this test better, especially with the advent of increasing surgery for functional gall bladder problems.
