Patients with upper
abdominal pain,
nausea, and
vomiting are often evaluated with ultrasound to diagnose symptomatic
cholelithiasis or
cholecystitis. With a normal ultrasound, a hepatobiliary
iminodiacetic acid (
HIDA) scan with ejection fraction (EF) is recommended to evaluate gallbladder function. The purpose of this study was to evaluate whether the
HIDA scan with EF was appropriately utilized in considering
cholecystectomy. Over 18 months, we performed 1533
HIDA scans with EF. After exclusion, 1501 were analyzable, 438 of whom underwent
laparoscopic cholecystectomy. Patients were divided into two groups: those with typical and atypical symptoms of biliary
colic. Our primary endpoint was symptom resolution of those who underwent
laparoscopic cholecystectomy. Symptom resolution was assessed by chart review of postop visits or readmissions. In patients with typical symptoms, resolution occurred in 66 per cent of patients with positive
HIDA and 77 per cent with negative
HIDA (P = 0.292). In patients with atypical symptoms, resolution occurred in 64 per cent of patients with positive
HIDA and 43 per cent with negative
HIDA (P = 0.013). A
HIDA scan with EF was not useful in patients with typical symptoms of biliary
colic and negative ultrasounds, and should not be used to make a decision for
cholecystectomy. However, this test can be helpful in patients with atypical symptoms, as it does predict symptom improvement in this group.