Quantitative 99mTc-DISIDA scanning and endoscopic biliary manometry in sphincter of Oddi dysfunction

Area of Science:

• Hepatobiliary imaging
• Gastroenterology
• Diagnostic technology

Background:

• Sphincter of Oddi (SO) dysfunction is a known cause of pain after gallbladder removal.
• Diagnosing SO dysfunction is challenging, often requiring invasive endoscopic biliary manometry (EBM).
• Non-invasive diagnostic methods are needed for suspected SO dysfunction.

Purpose of the Study:

• To evaluate quantitative cholescintigraphy as a non-invasive screening test for SO dysfunction.
• To compare scintigraphic findings in patients with SO dysfunction, non-biliary pain, and asymptomatic controls.

Main Methods:

• Quantitative 99mTc-DISIDA scans (60 minutes) were performed on three groups: SO dysfunction (n=10), non-biliary pain (n=10), and asymptomatic controls (n=10).
• Computer analysis of activity/time curves from the hepatobiliary system (region-of-interest).
• Key metrics assessed: time to maximum counts (Tmax) and percentage of biliary tracer emptied.

Main Results:

• Patients with SO dysfunction had significantly increased Tmax compared to both control groups (p < 0.001).
• The SO dysfunction group showed significantly less biliary tracer emptied at 45 and 60 minutes (p < 0.01 and p < 0.02, respectively).

Conclusions:

• Quantitative cholescintigraphy demonstrates potential as a valuable non-invasive screening tool for suspected Sphincter of Oddi dysfunction.
• This imaging technique can help differentiate SO dysfunction from other causes of postcholecystectomy pain.