E. Wiesner1,2, L. Martin1,2, W. Peche1,2, J. Langell1,2 1University Of Utah,Department Of Surgery,Salt Lake City, UT, USA 2VA Salt Lake City Health Care System,Center Of Innovation,Salt Lake City, UT, USA
Introduction: The diagnosis of biliary dyskinesia (BD) remains somewhat controversial. However, the Rome IV Criteria for Functional Gastrointestinal Disorders outlines the clinical diagnostic requirements for BD. Many authors also recommend supportive confirmation of the diagnosis with cholecystokinin (CCK)-stimulated cholescintigraphy (hepatobiliary iminodiacetic acid [HIDA] scan) and calculation of gallbladder ejection fraction (GBEF). No prior studies have evaluated the consistency and utility of repeat HIDA-GBEF imaging in patients with suspected BD. Here, we conducted a retrospective study to evaluate HIDA-GBEF consistency overtime among patients with suspected BD.
Methods: We queried the Veteran’s Healthcare Administration National Corporate Data Warehouse from January 2005 to July 2016 for patients who underwent more than one HIDA. Patients undergoing HIDA for a suspected diagnosis of BD were included. Radiology reports were reviewed and the GBEF for each study was abstracted. The data were analyzed for changes in GBEF over time, specifically evaluating differences between studies and cross over from abnormal-to-normal and normal-to-abnormal diagnostic criteria.
Results: We identified 546 patients who underwent more than one HIDA scan during the study period. 522 underwent two HIDA scans, 23 underwent three HIDA scans, and 1 underwent four HIDA scans. The initial EF was reported as normal in 365 patients (mean GBEF 68% +/-19) and reduced in 181 patients (mean GBEF 17% +/-10). Of the patients with an initially normal GBEF, 97 patients (27%) had a reduced EF on subsequent imaging (average GBEF 64+/-19% versus 19.7+/-14%) with a mean time between studies of 33.7 months. Of the patients with an initially low GBEF, 81 patients (45%) had a normal EF on subsequent imaging (average GBEF 18+/-11% versus 73+/-44%) with a mean time of 26.53 months between studies.
Conclusion: We found substantial variation in repeat HIDA scan data over time with about one-third of patients demonstrating a change in diagnostic criteria. These data suggest that HIDA scan GBEF may have a low precision, calling into question its clinical value in the evaluation of BD. Additional studies are necessary to determine the utility of HIDA-GBEF in the evaluation of patients with suspected BD.