What is the role of the cholecystokinin stimulated HIDA scan in evaluating abdominal pain in children?
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Read the article on jpedsurg.org ↗Article · May 2020 · 1 min read
In brief
In brief
Retrospective study of 124 pediatric patients questions the utility of CCK-HIDA scans for selecting cholecystectomy candidates with abdominal pain. Analysis found no ejection fraction threshold predictive of symptom resolution post-surgery, suggesting the test poorly identifies children who will benefit from gallbladder removal.
Written by the GCMD Library team from the article.
Abstract
Purpose
Cholecystokinin stimulated HIDA (CCK-HIDA) has been used to identify patients with biliary dyskinesia and select patients likely to benefit from cholecystectomy. The appropriate use of this study in children remains controversial and this study aims to better understand the utility of this test.
Methods
Children who underwent a CCK-HIDA for evaluation of abdominal pain over a 15-year period were included, after excluding infants and patient's s/p liver transplant. Relevant clinical and outcomes data were abstracted and analyzed.
Results
124 patients met inclusion criteria. Mean age was 14.5 ± 2.6 years, Mean BMI was 27.9 ± 9.9 and 96 (77.4%) presented with right upper quadrant or epigastric pain. The mean ejection fraction (EF) was 58.5 ± 31.8%, with 37 (29.8%) < 35% EF. Using receiver operating curve analysis no specific EF threshold value predictive of resolution of symptoms was identified (AUC 0.510; p = 0.94). Using EF <35% and >35% and <20% and >20%, no association was noted with partial/complete resolution of symptoms. On multivariate regression analysis neither EF nor pain reproduction with CCK administration were independently associated with resolution of symptoms.
Conclusions
These data suggest that the CCK-HIDA scan is a poor predictor of benefit from cholecystectomy. Prospective large studies would help in identifying better criterion for patient selection, especially with the trend of increasing surgery for functional gallbladder disorders.
Type of Study
Case cohort.
Level of Evidence
IV.