Evaluation of common bile duct stenosis in chronic pancreatitis using cholescintigraphy

To evaluate a stenotic change of the common bile duct (CBD) in chronic pancreatitis (CP), cholescintigraphy with 99mTc-N-pyridoxyl-5-methyltryptophan (PMT) was performed in 28 patients with CP and 15 normal subjects. The patients were divided into 3 groups on the basis of their endoscopic retrograde cholangiopancreatography (ERCP) findings: minimal CP (MIP; n = 14), moderate CP (MOP; n = 10), and advanced CP (ADP; n = 4). After intravenous injection of 5 mCi 99mTc-PMT, digital images were obtained and time activity curves of the ROIs (liver, hepatic duct, gallbladder, and duodenum) were generated. No radioactivity was seen in the duodenum within 1 hour in 12 of 28 (43%) with CP and 2 of 15 (13%) normals. Reflux to the hepatic duct after cerulein injection was found in 6 of 20 (30%) examined patients with CP and more frequently in ADP, whereas there was no reflux in MIP and normals. When the finding of reflux in cholescintigraphy was interpreted as positive for CBD stenosis, the sensitivity, specificity, and accuracy were 100%, 88%, and 90%, respectively. We conclude that reflux is a reliable scintigraphic finding in detecting CBD stenosis.