Utilization of cholecystokinin cholescintigraphy in clinical practice

Bryan K. Richmond, John Dibaise, Harvey Ziessman

Research output: Contribution to journalReview article

13 Scopus citations

Abstract

Based on review of the current literature on this topic, it seems appropriate to conclude the following: 1. The use of CCK-HIDA scan (and GBEF) to select which patients with pain of biliary origin should undergo cholecystectomy is an acceptable practice under current Society of Gastrointestinal and Laparoendoscopic Surgeons (SAGES) clinical guidelines. 2. The use of the CCK-HIDA should be restricted to those patients meeting criteria for gallbladder dyskinesia/ functional biliary pain according to established criteria, such as those proposed by the Rome III committee. The use of CCK-HIDA in the investigation of atypical symptoms should be avoided. 3. No substantial large scale data exist to suggest that symptom reproduction with CCK injection (or degree of GBEF decrease) is predictive of relief of symptoms by cholecystectomy, and although they may be considered in the overall clinical picture, they should not be used to select patients for surgery. 4. Clinicians should adhere to the recommendations of the SNM guidelines with respect to the conduct of the CCK-HIDA scan, (including which medications should be held before testing), to minimize the risk of a false positive scan. 5. Surgeons should take an active role in ensuring that their hospital's nuclear medicine and radiology staff are in compliance with current SNM guidelines for CCK-HIDA administration protocols pertaining to CCK dosing, infusion timing, rate and duration, and calculation of normal values. Attention should be given to the conduct of the test as specified in the report when patients are referred from outside institutions, which may not be current and compliant with updated SNM guidelines. 6. Clinicians should be reminded that normal vs abnormal CCK-HIDA values are based on results obtained in normal subjects. By definition then, the test itself is not predictive of a disease state and represents only 1 piece of the clinical information used to select surgical candidates for the treatment of gallbladder dyskinesia. 7. An adequately powered, randomized, prospective, controlled trial is needed to definitively investigate the role of CCK-HIDA scan in the diagnosis of gallbladder dyskinesia and in patient selection for cholecystectomy. The fact that the National Institutes of Health is currently sponsoring a large, multicenter trial evaluating predictors and interventions in sphincter of Oddi dysfunction (EPISOD trial)35 suggests that such a trial can be performed in patients with functional biliary pain and an intact gallbladder. This would be a welcome addition to the current literature, and would contribute greatly to resolving many of the dilemmas surrounding the evidence-based treatment of this challenging patient population.

Original languageEnglish (US)
Pages (from-to)317-323
Number of pages7
JournalJournal of the American College of Surgeons
Volume217
Issue number2
DOIs
StatePublished - Aug 1 2013

Keywords

  • CCK
  • CCK-HIDA
  • GBEF
  • HIDA
  • SNM
  • Society of Nuclear Medicine
  • cholecystokinin
  • cholecystokinin-cholescintigraphy
  • gallbladder ejection fraction
  • hepatobiliary iminodiacetic acid

ASJC Scopus subject areas

  • Surgery

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