technetium-tc-99m-disofenin and Pain--Postoperative

The ideal noninvasive test of sphincter of Oddi dysfunction (SOD) does not exist and the diagnosis of patients with postcholecystectomy pain often relies on invasive procedures. In this paper we describe a scintigraphic test for SOD: the scintigraphic score. This score combines quantitative and visual criteria for interpretation of hepatobiliary scans. Twenty-six consecutive postcholecystectomy patients underwent hepatobiliary imaging, ERCP, and sphincter manometry. Twelve patients had SOD and 14 had normal sphincters determined by clinical findings, ERCP, and manometric studies. All patients with normal sphincter had scores of 0-4, while patients with SOD had values of 5-12 for a perfect sensitivity and specificity of 100%. Hepatobiliary scans scored in this fashion may become the noninvasive test of choice to screen postcholecystectomy patients with suspected SOD.

Topics: Adult; Aged; Aged, 80 and over; Cholecystectomy; Cholecystokinin; Common Bile Duct Diseases; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Pain, Postoperative; Radionuclide Imaging; Retrospective Studies; Sphincter of Oddi; Technetium Tc 99m Disofenin

Scintigraphy of the biliary system using 99mTc di-isopropyl iminodiacetic acid (DIDA) was performed in 65 subjects who had previously undergone cholecystectomy. Of the 65 subjects, 20 were free of pain and 45 had biliary-type pain both with (group I) and without (group II) features of sphincter of Oddi dysfunction. This dysfunction comprised dilatation of the bile duct, a transient rise in serum levels of liver enzymes after episodes of pain, or both abnormalities. After computer acquisition of images at intervals of 60 seconds for at least 90 minutes, time/activity curves were generated for five regions of interest: liver, common hepatic duct, common bile duct, duodenum, and background. The time at which counts in the common bile duct reached 50% of maximum (CBD T50) and the time of first entry of isotope into the duodenum (TD) were used to compare asymptomatic subjects with those with biliary-type pain. Patients in group I, but not those in group II, showed significant prolongation of CBD T50 (p less than 0.002) and TD (p less than 0.02) when compared to values in asymptomatic subjects. Six patients had a second scan at six to 12 months after endoscopic sphincterotomy and all showed a reduction in values for CBD T50 and TD. In patients with pain, a significant correlation was shown between bile duct diameter and CBD T50 (p less than 0.01) and between bile duct diameter and TD (p less than 0.02) but results from scintigraphy were independent of responses to morphine-neostigmine and motility in the sphincter of Oddi as assessed by endoscopic manometry.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Ampulla of Vater; Biliary Dyskinesia; Cholecystectomy; Common Bile Duct Diseases; Female; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Pain, Postoperative; Radionuclide Imaging; Sphincter of Oddi; Technetium Tc 99m Disofenin