technetium-tc-99m-disofenin and Pain

Patients with suspected functional biliary pain often undergo cholecystectomy if a decreased gall-bladder ejection fraction (GBEF <35%) is demonstrated by cholecystokinin cholescintigraphy. However, the validity of GBEF in predicting which patients will have symptomatic relief following cholecystectomy is unclear.. To determine whether patients with suspected functional biliary pain with decreased GBEF have a better symptomatic outcome after cholecystectomy than those with normal GBEF.. Systematic review and meta-analysis of the published literature through MEDLINE and EMBASE databases.. We included nine studies with a total of 974 patients with suspected functional biliary pain; 362 patients underwent cholecystectomy. Most studies assessed outcome by direct patient interview. Mean ages across the studies ranged from 35 to 47 years; 78% of all patients were female. Mean duration of follow-up after surgery ranged from 1 to 2.5 years. After cholecystectomy, 94% of the patients with reduced GBEF had a positive outcome compared to 85% among those with normal GBEF. The pooled Mantel-Haenszel odds ratio for positive outcome was 1.37 (95% confidence interval 0.56-3.34), P=0.56.. These data do not support the use of GBEF to select patients with suspected functional biliary pain for cholecystectomy. Prospective randomized trials are required if this practice is to be evidence-based.

Topics: Cholecystectomy; Cholecystokinin; Gallbladder; Gallbladder Diseases; Gallbladder Emptying; Humans; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Disofenin; Treatment Outcome

The patterns of radionuclide hepatobiliary scans in nine children with sickle cell disease and acute right upper quadrant abdominal pain were reviewed. The most common pattern observed was delayed gall bladder visualization, consistent with chronic cholecystitis. The value of hepatobiliary imaging in distinguishing acute cholecystitis from crisis is presented.

Topics: Abdomen; Acute Disease; Adolescent; Anemia, Sickle Cell; Biliary Tract; Child; Cholecystitis; Diagnosis, Differential; Female; Humans; Imino Acids; Liver; Male; Pain; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin

Topics: Abdomen; Acute Disease; Cholangiography; Cholecystitis; Cholecystography; Cholestasis; Common Bile Duct; Gallbladder; Humans; Imino Acids; Intestine, Small; Pain; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Ultrasonography

Hepatobiliary scans using Tc-IDA are reliable in making the diagnosis of acute cholecystitis. Commonly, opioid drugs are administered in patients with acute cholecystitis to relieve pain. Opioid drugs cause biliary sphincter spasm. Whether these drugs adversely affect hepatobiliary scans is unknown. We studied 13 healthy volunteer subjects, performing three hepatobiliary scans in each one. Scans were performed without opioid drugs and 30 minutes after intramuscularly administered meperidine, morphine, hydroxyzine, hydroxyzine plus meperidine, butorphanol, and nalbuphine. Opioid drugs markedly delayed clearance of Tc-IDA from the common bile duct, simulating common bile duct obstruction. Hydroxyzine alone caused an insignificant delay. We have concluded that opioid drugs cause bile duct obstruction in healthy persons. If opioid drugs are administered before a diagnostic hepatobiliary scan, delayed clearance of Tc-IDA from the common bile duct might lead to an erroneous diagnosis and indicate a potentially unnecessary common bile duct exploration. Opioid drugs should not be administered for several hours before a diagnostic hepatobiliary scan.

Topics: Acute Disease; Adult; Biliary Tract; Cholecystitis; Cholestasis; Female; Humans; Hydroxyzine; Imino Acids; Liver; Meperidine; Organotechnetium Compounds; Pain; Radionuclide Imaging; Technetium; Technetium Tc 99m Disofenin; Time Factors

Cholescintigraphy with Tc-99m iminodiacetic acid (IDA) agents has proved to be a convenient, non-invasive method for evaluating patients with suspected cholecystitis. (1,2) We recently examined two patients who were being evaluated for abdominal pain. The etiology of the two abnormal cholescintigrams was later proven to be due to nonhepatobiliary pathology.

Topics: Abdomen; Adult; Ampulla of Vater; Biliary Tract; Common Bile Duct Diseases; Duodenal Ulcer; Humans; Imino Acids; Male; Middle Aged; Morphine; Pain; Radionuclide Imaging; Spasm; Sphincter of Oddi; Technetium; Technetium Tc 99m Disofenin

Topics: Abdomen; Candidiasis; Colonic Diseases; Gallbladder Diseases; Humans; Imino Acids; Male; Middle Aged; Pain; Technetium; Technetium Tc 99m Disofenin; Ultrasonography