ASSESSMENT OF BILE FLOW BY RADIOSCINTIGRAPHY IN PATIENTS WITH BILIARY-TYPE PAIN AFTER CHOLECYSTECTOMY

Scintigraphy of the biliary system using ^99mTc di-isopropyl iminodiacetic acid (DIDA) was performed in 65 subjects who had previously undergone cholecystectomy. Of the 65 subjects, 20 were free of pain and 45 had biliary-type pain both with (group I) and without (group II) features of sphincter of Oddi dysfunction. This dysfunction comprised dilatation of the bile duct, a transient rise in serum levels of liver enzymes after episodes of pain, or both abnormalities. After computer acquisition of images at intervals of 60 seconds for at least 90 minutes, time/activity curves were generated for five regions of interest: liver, common hepatic duct, common bile duct, duodenum, and background. The time at which counts in the common bile duct reached 50% of maximum (CBD T50) and the time of first entry of isotope into the duodenum (TD) were used to compare asymptomatic subjects with those with biliary-type pain. Patients in group I, but not those in group II, showed significant prolongation of CBD T50 (p<0.002) and TD (p<0.02) when compared to values in asymptomatic subjects. Six patients had a second scan at six to 12 months after endoscopic sphincterotomy and all showed a reduction in values for CBD T50 and TD. In patients with pain, a significant correlation was shown between bile duct diameter and CBD T50 (p<0.01) and between bile duct diameter and TD (p<0.02) but results from scintigraphy were independent of responses to morphine-neostigmine and motility in the sphincter of Oddi as assessed by endoscopic manometry. Some patients in group I had delayed excretion of DIDA into the duodenum and this correlated with the degree of dilatation of the biliary system.