Abstract
During times of sincalide shortage, a fatty meal can be used to stimulate gallbladder contraction during hepatobiliary scintigraphy. However, if a patient has an abnormal gallbladder ejection fraction (GBEF), is it chronic cholecystitis or is it inadequate cholecystokinin stimulation due to poor gastric emptying? Hence, simultaneous liquid gastric emptying using 99mTc-sulfur colloid along with corn oil emulsion was initiated as routine practice during the 2014 sincalide shortage in patients evaluated for GBEF. The objective of this study was to retrospectively assess the time course of gastric emptying in these patients, especially with regard as to whether delayed gastric emptying might be a factor in some patients with a poor GBEF. Methods: Our clinical imaging procedure during the 2014 sincalide shortage consisted of routine 99mTc-mebrofenin hepatobiliary scintigraphy followed by corn oil emulsion and 99mTc-sulfur colloid orally. Dynamic imaging with regions of interest encompassing the gallbladder and the stomach allowed determination of GBEF and of gastric emptying. For this study, imaging records for 53 consecutive patients undergoing this clinical procedure were reviewed. The time for 1/2 gastric emptying, along with % gastric emptying at the end of imaging, were evaluated in relationship to GBEF. Results: 17 patients had normal GBEF (74 ± 14%) and satisfactory gastric emptying (31 ± 21 min for 1/2 emptying, 75 ± 14% emptying at end of imaging); 17 patients had normal GBEF (77 ± 17%) in spite of unsatisfactory gastric emptying (only 30 ± 14% emptying at end of imaging); 5 patients had abnormal GBEF (19 ± 9%) and satisfactory gastric emptying (26 ± 19 min for 1/2 emptying, 82 ± 14% emptying at end of imaging), supporting a diagnosis of chronic cholecystitis; 11 patients had abnormal GBEF (26 ± 9%) but also unsatisfactory gastric emptying (only 26 ± 13% emptying at end of imaging), which did offer additional support for a diagnosis of chronic cholecystitis; and 3 patients had borderline GBEF (40 ± 2%) with satisfactory gastric emptying (59 ± 6% emptying at end of imaging). Conclusion: Simultaneous liquid gastric emptying can provide additional information in the interpretation of GBEF when using a fatty meal as an oral cholecystagogue, especially to help differentiate chronic cholecystitis vs. inadequate cholecystokinin stimulation due to poor gastric emptying.