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Clinical Impact of Nonvisualization

Ryan F. Holbrook, MD; Francine L. Jacobson, MD, MPH; Roger T. Pezzuti, MD; Douglas A. Howell, MD

Arch Surg. 1991;126(6):738-742.

Abstract
• We prospectively performed nuclear biliary patency imaging (HIDA scanning) in 62 patients who had undergone endoscopic retrograde sphincterotomy for management of pancreaticobiliary disease with their gallbladders in situ. Elective cholecystectomy was not recommended because of advanced age, comorbidity, or absence of gallstones. All patients had patent cystic ducts at endoscopic retrograde cholangiopancreatography balloon cholangiography. Eighteen (29.1%) of 62 patients had nonvisualizing HIDA scans, and in 44 (70.9%) of 62 visualization was normal or delayed. Six cholecystectomies were required for colic (n=1), acute cholecystitis (n = 4), and acute cholecystocholedochal fistula with cholangitis (n = 1). Among the patients with cholelithiasis and nonvisualization (n = 13), five (38.5%) required surgery, whereas only one (4.8%) of 21 patients with cholelithiasis and visualization required surgery. Nonvisualizing HIDA scans are frequent (30%) after endoscopic retrograde sphincterotomy and have no clinical relevance in patients without cholelithiasis but predict the need for cholecystectomy within 16 months in 38.5% of patients with cholelithiasis.

(Arch Surg. 1991;126:738-742)

Author Affiliations
From the Departments of Surgery (Dr Holbrook), Radiology (Drs Jacobson and Pezzuti), and Gastroenterology (Dr Howell), Maine Medical Center, Portland.

Footnotes
Accepted for publication February 28, 1991.

Read before the 71st Annual Meeting of the New England Surgical Society, Newport, RI, September 15, 1990.

Reprint requests to 131 Chadwick St, Portland, ME 04102 (Dr Howell).

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