SO manometry is at present the “gold standard” investigation for patients with suspected biliary SO dysfunction. However, this procedure is invasive and carries a significant risk of pancreatitis. Noninvasive cholescintigraphy in cholecystectomised patients with a scoring system of six variables1and also the transit time from the hepatic hilum to the duodenum2 have been promoted as sensitive and specific. Aim: To evaluate the cholescintigraphic scoring system and transit time in patients with suspected biliary SO dysfunction undergoing SO manometry. Methods: Cholecystectomised patients undergoing SO manometry for persistent biliary type pain for which all other causes had been excluded were prospectively studied. Cholescintigraphy (1 minute frames for 1 hour) with cholecystokinin-octapeptide infusion was performed within a week prior to manometry. Scoring of the scans was performed by two independent blinded observers. Scores were defined as abnormal or normal as previously described1. Measurement of transit times was not blinded. Transit times were defined as abnormal if >9 minutes. Manometry of the biliary sphincter was performed per-endoscopically and defined as abnormal if the basal pressure was >40 mmHg. Results: 26 patients were enrolled (all female, mean age 46.9 years, cholelithiasis 69.2%, mean time since surgery 8.6 years, mean time pain free since surgery 3.0 years). 2 patients were excluded from analysis because manometry was performed from the pancreatic sphincter. 7 patients had abnormal manometry. Cholescintigraphic scoring (95% CI) had a sensitivity of 42.9%, a specificity of 64.7%, odds ratio (OR) of 1.38 (0.23-8.3), positive predictive value (PPV) of 33% (9-69), and a negative predictive value (NPV) of 73% (45-91). The coefficient of variation (kappa) for interobserver variation in scores that lead to a change from either normal to abnormal or vice-versa was 0.56. Transit time sensitivity was 50%, specificity 94.1%, OR 16.0 (1.22-210.6), PPV 75% (22-99), and NPV 84% (60-96). Conclusions: Whilst this is a preliminary report, these results suggest that both methods of cholescintigraphic analysis are poor predictors of biliary SO dysfunction but that the transit time may be a more useful screening test to exclude suspected biliary SO dysfunction. The transit time findings need to be further assessed by a blinded observer. 1Sostre et al, J Nuc Med 1992; 33: 1216-22 2Corazziari et al, DDS 1994; 39: 1985-93 SO manometry is at present the “gold standard” investigation for patients with suspected biliary SO dysfunction. However, this procedure is invasive and carries a significant risk of pancreatitis. Noninvasive cholescintigraphy in cholecystectomised patients with a scoring system of six variables1and also the transit time from the hepatic hilum to the duodenum2 have been promoted as sensitive and specific. Aim: To evaluate the cholescintigraphic scoring system and transit time in patients with suspected biliary SO dysfunction undergoing SO manometry. Methods: Cholecystectomised patients undergoing SO manometry for persistent biliary type pain for which all other causes had been excluded were prospectively studied. Cholescintigraphy (1 minute frames for 1 hour) with cholecystokinin-octapeptide infusion was performed within a week prior to manometry. Scoring of the scans was performed by two independent blinded observers. Scores were defined as abnormal or normal as previously described1. Measurement of transit times was not blinded. Transit times were defined as abnormal if >9 minutes. Manometry of the biliary sphincter was performed per-endoscopically and defined as abnormal if the basal pressure was >40 mmHg. Results: 26 patients were enrolled (all female, mean age 46.9 years, cholelithiasis 69.2%, mean time since surgery 8.6 years, mean time pain free since surgery 3.0 years). 2 patients were excluded from analysis because manometry was performed from the pancreatic sphincter. 7 patients had abnormal manometry. Cholescintigraphic scoring (95% CI) had a sensitivity of 42.9%, a specificity of 64.7%, odds ratio (OR) of 1.38 (0.23-8.3), positive predictive value (PPV) of 33% (9-69), and a negative predictive value (NPV) of 73% (45-91). The coefficient of variation (kappa) for interobserver variation in scores that lead to a change from either normal to abnormal or vice-versa was 0.56. Transit time sensitivity was 50%, specificity 94.1%, OR 16.0 (1.22-210.6), PPV 75% (22-99), and NPV 84% (60-96). Conclusions: Whilst this is a preliminary report, these results suggest that both methods of cholescintigraphic analysis are poor predictors of biliary SO dysfunction but that the transit time may be a more useful screening test to exclude suspected biliary SO dysfunction. The transit time findings need to be further assessed by a blinded observer. 1Sostre et al, J Nuc Med 1992; 33: 1216-22 2Corazziari et al, DDS 1994; 39: 1985-93