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CC BY-NC-ND 4.0 · World J Nucl Med 2022; 21(03): 231-235
DOI: 10.1055/s-0042-1751038
Original Article

Role of 99mTc-Mebrofenin Hepatobiliary Scintigraphy in the Diagnosis of Post Cholecystectomy Syndrome

S. Durga Sowmya
1   Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Amit Gupta
1   Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Manishi L. Narayan
2   Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Udit Chauhan
3   Department of Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Jaydeep Jain
1   Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Tanuj Singla
1   Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Jaine John Chennatt
1   Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Abstract

Background Huge variation in the prevalence of post cholecystectomy syndrome (PCS) is because PCS can include a wide variety of disorders that can be both related and unrelated to cholecystectomy. Hepatobiliary scintigraphy (HBS) is a noninvasive nuclear medicine scan that can evaluate a delay in the transit of bile from the hepatic hilum to the duodenum using a radiotracer 99mTc-Mebrofenin that can be associated with a functional ampullary obstruction. The aim of this study was to assess the role of 99mTc-Mebrofenin HBS in the detection of the cause of PCS among the patients undergoing cholecystectomy.

Methods Twenty-one patients who presented with PCS from September 2018 to February 2020 were included in the study. These patients were characterized based on history, examination, liver function test, and abdominal ultrasound. Sphincter of Oddi dysfunction (SOD) was diagnosed using the Rome 3 criteria and the Milwaukee classification. Magnetic resonance cholangiopancreatography (MRCP) and upper gastrointestinal endoscopy and biopsy were done when indicated, to establish the diagnosis. These patients were further subjected to 99mTc-Mebrofenin HBS, and the findings were analyzed.

Results The most common symptom in PCS was biliary pain occurring in 85.7% of the patients. The average time of presentation since surgery was 1.9 years. The most common cause of PCS was SOD, occurring in 52.3% of the patients, followed by benign biliary stricture occurring in 23.8% of the patients. The mean bile duct (common bile duct) visualization time in patients with PCS was 25.2 minutes, the mean duodenal visualization time was 38.2 minutes, and the mean jejunal visualization time was 60.5 minutes. The mean bile duct to duodenum transit time was 12.7 minutes, while the mean bile duct to jejunum transit time was 30.1 minutes. HBS showed consistent findings with the final diagnosis made by other diagnostic modalities (clinical criteria/MRCP/intraoperative findings) in 80.9% of the patients.

Conclusion 99mTc-Mebrofenin HBS has a significant role in the evaluation of PCS.

Keywords

hepatobiliary scintigraphy - sphincter of Oddi dysfunction - post cholecystectomy syndrome - radiotracer - bile duct - dyspepsia


Publication History

Article published online:
16 August 2022

© 2022. World Association of Radiopharmaceutical and Molecular Therapy (WARMTH). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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