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Is biliary scintigraphy a reliable diagnostic tool for biliary dyskinesia in children?
1Division of Pediatric Gastroenterology, UIC College of Medicine at Peoria, Children's Hospital of Illinois at OSF St Francis Hospital, Peoria, IL, USA. smisra@pol.net
Insights
Hepatobiliary scintiscan (HIDA) results do not reliably predict long-term outcomes for children with biliary dyskinesia. Interventions after abnormal HIDA scans showed improved short-term, but worse long-term, prognosis.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Biliary Tract Disorders
Background:
- Functional biliary tract disease in children is challenging to diagnose.
- Hepatobiliary scintiscan (HIDA) is used, but its prognostic value is unstudied.
- Biliary dyskinesia diagnosis often follows inconclusive gastrointestinal workups.
Purpose of the Study:
- To evaluate HIDA scan results as long-term prognostic indicators.
- To assess the role of HIDA scans in children with suspected biliary dyskinesia.
- To determine if HIDA scans predict outcomes with or without intervention.
Main Methods:
- Retrospective chart review of children with HIDA scans for chronic abdominal symptoms.
- Standardized HIDA scan protocol.
- Telephonic survey 5 years post-scan for long-term outcome assessment.
Main Results:
- 42 of 61 children had abnormal HIDA scans.
- No significant difference in short-term or long-term outcomes between normal and abnormal HIDA groups.
- Intervention in abnormal HIDA group improved short-term but worsened long-term prognosis.
Conclusions:
- HIDA scan results are not reliable prognostic indicators for pediatric biliary dyskinesia.
- Caution is advised when using HIDA scans for surgical intervention selection.
- Further prospective studies are needed to define pediatric biliary dyskinesia.
Background And Aim:
The role of hepatobiliary scintiscan (HIDA) in children suspected to be having functional biliary tract disease has not been studied. We evaluated HIDA scan results as long-term prognostic indicators for biliary dyskinesia with or without intervention.
Methods:
Children who had HIDA scan for chronic abdominal pain, nausea, or vomiting were included. These children had inconclusive gastrointestinal diagnostic workup. HIDA scan was performed according to a standardized protocol. Clinical data were collected by retrospective chart review. A telephonic survey was done 5 years after the initial HIDA scan to document long-term outcome.
Results:
Forty-two of 61 children had abnormal HIDA scan. There was no difference between children with normal and abnormal HIDA results in clinical presentations, short-term (85.7% and 84.2%) and long-term (64.9% and 60%) outcomes. Twenty-seven of the 42 children with abnormal scan results underwent interventions (21 cholecystectomy only, 4 cholecystectomy followed by sphincter of Oddi sphincterotomy, and 2 sphincterotomy only). After intervention, children with abnormal HIDA scan had better short-term prognosis (88.9% and 54.5%), but their long-term prognosis (52.2% and 85.7%) was worse than those without intervention. No clinical prognostic factor could be identified.
Conclusions:
HIDA scan result is not a good prognostic indicator in children with suspected biliary dyskinesia. Caution should be exercised while using HIDA scan for selecting patients for surgical intervention. Focused prospective studies are needed to define biliary dyskinesia in children.
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