Biliary patency imaging after endoscopic retrograde sphincterotomy with gallbladder in situ. Clinical impact of nonvisualization
R. F. Holbrook, F. L. Jacobson, R. T. Pezzuti and D. A. Howell
Department of Surgery, Maine Medical Center, Portland.
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.
