Hepatobiliary scan for assessing disease severity in patients with cholelithiasis

To evaluate the role of a hepatobiliary scan for predicting the severity of cholecystitis and the difficulty of laparoscopic cholecystectomy.

Prospective study.

Department of surgery at a tertiary university hospital.

From July 1, 2004, through June 30, 2007, data from 941 patients who underwent a preoperative hepatobiliary scan before laparoscopic cholecystectomy were prospectively recorded.

Prediction of the severity of cholecystitis.

The overall predictive value of the gallbladder ejection fraction (GBEF) for predicting acute cholecystitis was 82.9% (P < .001), and the sensitivity and specificity of the GBEF at a set point of 30.0% were 92.1% and 61.6%, respectively. The mean (SD) severity of the cholecystitis score and the difficulty in performing laparoscopic cholecystectomy scores in the patients with gallbladder nonvisualization or a GBEF less than 30.0% (2.9 [2.5] and 0.5 [0.9], respectively) were significantly higher than those for the patients with a GBEF of 30.0% or higher (0.5 [1.1] and 0.3 [0.6]; P < .001 and P = .01, respectively). Moreover, the patients with gallbladder nonvisualization or a GBEF less than 30.0% experienced higher rates of complication after laparoscopic cholecystectomy than did the patients with a GBEF of 30.0% or higher (6.3% vs 2.6%; P = .006).

A hepatobiliary scan is useful for predicting the severity of cholecystitis, and a difficult laparoscopic cholecystectomy is predicted for patients with gallbladder nonvisualization or a GBEF less than 30.0%.