Scintigraphic sign of functional biliary obstruction is pathognomic for sphincter of Oddi dysfunction.
ABSTRACT Quantitative hepatobiliary scintigraphy (QHBS) is a valuable method for the detection of a low-grade biliary obstruction in patients with suspected sphincter of Oddi (SO) dysfunction (SOD), though the relatively low specificity of this noninvasive test has been criticized. The aim of the present study was a critical assessment of the diagnostic value of glyceryl trinitrate-augmented QHBS in patients with suspected SOD.
Glyceryl trinitrate-augmented QHBS and endoscopic retrograde cholangiopancreatography (ERCP) was performed on 27 cholecystectomized patients with suspected SOD.
In 14 patients the ERCP depicted organic causes of biliary obstruction (choledocholithasis, juxtapapillary diverticulum, Vater papilla adenoma and common bile duct stenosis). In 12 of the 13 patients with inconclusive ERCP, endoscopic SO manometry demonstrated an elevated SO basal pressure. In patients with manometrically confirmed SOD, glyceryl trinitrate administration significantly increased the radioactive bile transit into the duodenum and normalized the QHBS parameters. In contrast, the 14 patients with an organic biliary obstruction glyceryl trinitrate administration had no effect on the transpapillary bile flow.
In conclusion, glyceryl trinitrate-augmented QHBS is a specific method in the diagnosis of SOD, proving the functional reversibility of the biliary obstruction.
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Article: Biliary dyskinesia in pediatrics.[show abstract] [hide abstract]
ABSTRACT: Biliary dyskinesia is a potential cause for acalculous biliary colic in pediatric patients. A triad of symptoms and signs, consisting of abdominal pain (with or without associated nausea or fatty food intolerance), absence of gallstones, and an abnormally low cholecystokinin-stimulated gallbladder ejection fraction is used to diagnose the disorder. In several small pediatric case series, cholecystectomy resulted in symptomatic improvement in a majority of patients with biliary dyskinesia. However, the diagnosis of biliary dyskinesia and appropriate management remain controversial. This review discusses the purported pathophysiology of biliary dyskinesia and the data available regarding diagnosis and treatment of this entity in the pediatric population.Current Gastroenterology Reports 05/2006; 8(2):172-6.
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ABSTRACT: Chronic acalculous gallbladder and chronic acalculous biliary disease are considered functional hepatobiliary diseases. Cholescintigraphy provides physiologic imaging of biliary drainage, making it ideally suited for their noninvasive diagnosis. For chronic acalculous gallbladder disease, calculation of a gallbladder ejection fraction during sincalide cholescintigraphy can confirm the clinical diagnosis and has become a common routine procedure in many nuclear medicine clinics. Published data generally confirm a high overall accuracy for predicting relief of symptoms with cholecystectomy. However, data also exist suggesting it is not useful. The discrepant results probably are caused by the various different methodologies that have been used for sincalide infusion. Proper methodology of sincalide infusion is critical for providing accurate reproducible results, minimizing false positive studies, and preventing adverse side effects. The most common causes for the postcholecystectomy pain syndrome are partial biliary obstruction secondary to stones or tumor and sphincter of Oddi dysfunction. The latter is a partial biliary obstruction at the level of the sphincter. This has long been considered a functional hepatobiliary disease because of the lack of anatomical abnormalities. Sphincterotomy is the present treatment; however, diagnosis requires invasive procedures, such as endoscopic retrograde cholangiopancreatography and sphincter of Oddi manometry, which has a high complication rate and is not widely available. The unique ability of cholescintigraphy to image biliary drainage allows noninvasive diagnosis. Different methodologies have been reported, many with good overall accuracy. Various pharmacologic interventions and quantitative methodologies have been used in conjunction with cholescintigraphy to enhance its diagnostic capability. Further investigations are needed determine the optimal methodology; however, cholescintigraphic methods have already a clinical role in the diagnosis of sphincter of Oddi dysfunction and will be used increasingly in the future.Seminars in Nuclear Medicine 05/2006; 36(2):119-32. · 3.82 Impact Factor