To evaluate the role of quantitative cholescintigraphy with fatty meal in the management of
biliary dyskinesia and to describe the findings according to Sostre score (SS) criteria in patients with gallbladder (GB) in-situ and biliary
pain. We performed a retrospective analysis of the hepatobiliary (
HIDA) studies (n = 35) performed for evaluation of
biliary dyskinesia either due to biliary
pain,
opioid induced
sphincter of Oddi dysfunction (SOD), recurrent
pancreatitis (RP) or
post cholecystectomy syndrome (PCS). Gallbladder ejection fraction (GBEF) was calculated from the post fatty meal
HIDA images (excluding PCS patients). Studies with GBEF ≤40 % and SS >4 were considered to have cholecystopathy and SOD respectively. Three of the 13 patients with PCS had SS of 6 each, suggestive of SOD. Delayed biliary visualization (>15 min) and activity in common bile duct 60 min > liver 15 min were the specific features in these cases.
Opioid induced SOD patients had SS >4 with retrograde refilling of GB in one patient and normalization of the SS parameters after
nifedipine challenge in the other patient. Patients with RP and biliary
pain were stratified into four groups, normal (GBEF >40 % and SS ≤4), cholecystopathy (GBEF ≤40 % and SS ≤4), normal with SOD (GBEF >40 % and SS >4) and cholecystopathy with SOD (GBEF ≤40 % and SS >4). Four patients with intact GB had cholecystopathy with scintigraphic features of SOD. Quantitative cholescintigraphy with fatty meal and SS scoring identified
biliary dyskinesia and SOD in patients with biliary
pain, recurrent
pancreatitis and
post-cholecystectomy syndrome.