The diagnosis of papillary
stenosis, occasionally seen after
cholecystectomy, is confirmed by endoscopic retrograde cholangiopancreatography (ERCP), which demonstrates delayed emptying of
contrast material into the duodenum for more than 45 minutes. The authors assessed 2,6-dimethyl phenyl carbamoyl methyl
iminodiacetic acid labelled with technetium-99m (
99mTc HIDA) as a less invasive procedure in these circumstances by comparing it with the findings from ERCP. Twenty-six patients who had
pain after
cholecystectomy were studied by continuous 1-hour scintigraphy after injection of
99mTc HIDA. Biliary flow was estimated by measuring uptake and clearance of the entire liver and common bile duct. Volunteers who had no
pain after
cholecystectomy served as controls. Of the 26 study patients, all
99mTc HIDA scan findings were within the control range in 11. Of these, 10 had normal biliary drainage confirmed by ERCP. The one patient with delayed drainage did not improve after
endoscopic sphincterotomy. Two patients demonstrated pooling of
99mTc HIDA in cystic dilatations of the biliary tree, while the other 13 patients had obstruction of the distal common bile duct and impaired flow demonstrated on the
99mTc HIDA scan. All 13 of these patients had papillary
stenosis proven by ERCP. The authors conclude that
99mTc HIDA scanning is a valuable, minimally invasive method of diagnosing papillary
stenosis.