title: The role of (99m)technetium-labelled hepato imino diacetic acid (HIDA) scan in the management of biliary pain.
abstract: OBJECTIVE
  To assess the outcome of laparoscopic cholecystectomy on the basis of an abnormal provocative (99m)technetium-labelled hepato imino diacetic acid (HIDA) scan for patients with typical biliary pain and normal trans-abdominal ultrasound (TUS) scan.
  
  
  METHODS
  Prospective data were collected for 1201 consecutive patients with typical biliary symptoms. Patients who were found to have a normal TUS and upper GI endoscopy subsequently underwent cholescintigraphy (HIDA scan). Patients with an abnormal HIDA scan, i.e.<40% ejection fraction with Sincalide (cholecystokinin octapeptide)--were offered cholecystectomy. Symptoms and histology were reviewed postoperatively.
  
  
  RESULTS
  In all, 48/1201 (4%) patients with typical biliary symptoms had a normal ultrasound and endoscopy; 35/48 patients had an abnormal provocative HIDA scan and all underwent laparoscopic cholecystectomy. Histology in all cases revealed chronic cholecystitis and 18 patients had sludge or microlithiasis within the gallbladder. At 6-week follow-up, 31 of the 35 patients were completely asymptomatic or improved. Furthermore, 79% of patients remained symptom-free or improved at a median follow-up of 28.5 months (range 4-70).
  
  
  CONCLUSIONS
  HIDA scan is a useful clinical tool as an adjunct to the diagnosis and management of patients who present with typical biliary pain and a normal TUS scan.
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, UK.
authors.forename: K
authors.initials: K
authors.lastname: Riyad
authors.forename: C R
authors.initials: CR
authors.lastname: Chalmers
authors.forename: A
authors.initials: A
authors.lastname: Aldouri
authors.forename: S
authors.initials: S
authors.lastname: Fraser
authors.forename: K
authors.initials: K
authors.lastname: Menon
authors.forename: P J
authors.initials: PJ
authors.lastname: Robinson
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood