HPB P07 HIDA scan utilisation and its influence on the management of patients with Gallbladder Dysmotility Disorders – A Retrospective Multicentre Cohort Study

Abstract

Abstract Background Hepatobiliary Iminodiacetic Acid (HIDA) - Cholecystokinin (CCK) and fatty meal scan is widely used in the investigation of patients with acalculour biliary-like pain as they present a significant diagnostic and management challenge to the healthcare system. This scan detects functional capacity of gallbladder in the form of gallbladder ejection fraction (GBEF). GBEF of <35% is consistent with biliary dyskinesia and >80% with hyperkinesia, a recently postulated pathology. Laparoscopic cholecystectomy (LC) remains the treatment of choice of for both the entities. We performed audit of utility of HIDA scan and interpretation of its results across three sites. Methods A retrospective cohort study of patents undergoing HIDA scan across three hospitals between January 2015 and December 2022. Patients with biliary pain according to ROME IV criteria of functional GI disorders were included. Electronic case notes were reviewed and demographics, laboratory results of bilirubin and ALP, radiological investigations, endoscopy result and HIDA scan result. Results A total of 225 patients underwent HIDA scan; median age was 42 years (IQR 34-53) and 194 (86.2%) were female. Median time form the onset of symptoms to HIDA scan was 19 months (IQR 6-24). 35 (15.5%) had GBEF <35%, 157 (69.7%) with GBEF 36-79%, and 33 (14.6 %) had GBEF ≥80. 36 patients had LC after HIDA scan: 19 (52.7%) for biliary dyskinesia, 12 (33.3%) for microlithiasis and/or biliary sludge on EUS and 5 (13.8%) had it for symptoms but normal GBEF. Histopathology of 4 patients had normal gallbladder, while 27 had chronic cholecystitis and/or cholesterosis. Conclusions HIDA scan is vital investigation for recurrent biliary-like pain without presence of gallstones and gallbladder dysmotility is not uncommon in this group of patients. HIDA scan should be more liberally utilised to rule out gallbladder dysmotility. Reporting method of HIDA scan should also be standardised to help interpret the results accurately.