Role of biliary scintigraphy in management of bile leak.
BACKGROUND
Endoscopic biliary drainage is effective in the management of patients with postoperative bile leak. Evidently, it cannot be used in patients with completely tied-off common bile duct (CBD).


OBJECTIVE
To ascertain whether biliary excretion scintigraphy could reliably detect patients with tied-off CBD so that endoscopic retrograde cholangiography (ERC), an invasive test, could be avoided.


METHODS
Twelve patients with active bile leak (11 postcholecystectomy, one posttraumatic), in whom the biliary system was imaged by both 99m technetium mebrofenin biliary scintigraphy and ERC, were evaluated.


RESULTS
Bile leak was demonstrated in all the 12 patients by scintigraphy. In six of these, there was no visualization of radionuclide activity in the intestines; in three of these six patients, ERC showed a patent CBD potentially amenable to endoscopic drainage, whereas in the remaining three, there was complete obstruction presumably due to CBD tie-off during surgery.


CONCLUSIONS
Biliary excretion scintigraphy is unreliable for detecting complete biliary obstruction in patients with bile leak.
Khanduri
A
A
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.
Agarwal
D K
DK
Mittal
B R
BR
Choudhuri
G
G
D000328:Adult; D000814:Aniline Compounds; D001646:Bile; D001658:Biliary Fistula / Q000000981:diagnostic imaging* / Q000209:etiology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000209:etiology; D003135:Common Bile Duct / Q000601:surgery; D005260:Female; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008297:Male; D015609:Organotechnetium Compounds; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine