Enterogastric reflux in suspected acute cholecystitis

Area of Science:

• Nuclear Medicine
• Gastroenterology
• Diagnostic Imaging

Background:

• Hepatobiliary scintigraphy, specifically using Tc-99m disofenin, is a common tool for diagnosing gallbladder conditions.
• Enterogastric reflux, the backflow of intestinal contents into the stomach, is a potential finding during such imaging but its significance in acute cholecystitis is not fully established.

Purpose of the Study:

• To assess the prevalence and diagnostic value of enterogastric reflux in patients suspected of having acute cholecystitis.
• To determine the correlation between enterogastric reflux and surgically confirmed acute cholecystitis.

Main Methods:

• Ninety patients with suspected acute cholecystitis underwent Tc-99m disofenin hepatobiliary scintigraphy.
• Enterogastric reflux was assessed by observing the presence and clearance of radiotracer activity in the stomach.
• Correlation with surgical findings was performed for definitive diagnosis.

Main Results:

• Of 77 evaluable patients, 26% (20/77) demonstrated enterogastric reflux.
• Among patients with enterogastric reflux, 80% (16/20) had acute cholecystitis.
• The overall accuracy of enterogastric reflux for diagnosing acute cholecystitis was 86%, with 70% sensitivity and 93% specificity.

Conclusions:

• Enterogastric reflux observed during Tc-99m disofenin hepatobiliary scintigraphy is a valuable secondary sign of acute cholecystitis.
• The presence of reflux may be associated with duodenal irritation secondary to gallbladder inflammation.
• This finding can enhance the diagnostic capability of hepatobiliary scintigraphy for acute cholecystitis.