title: Is biliary scintigraphy a reliable diagnostic tool for biliary dyskinesia in children?
abstract: OBJECTIVE
  The role of hepatobiliary scintiscan (HIDA) in children suspected to be having functional biliary tract disease has not been studied. We evaluated HIDA scan results as long-term prognostic indicators for biliary dyskinesia with or without intervention.
  
  
  METHODS
  Children who had HIDA scan for chronic abdominal pain, nausea, or vomiting were included. These children had inconclusive gastrointestinal diagnostic workup. HIDA scan was performed according to a standardized protocol. Clinical data were collected by retrospective chart review. A telephonic survey was done 5 years after the initial HIDA scan to document long-term outcome.
  
  
  RESULTS
  Forty-two of 61 children had abnormal HIDA scan. There was no difference between children with normal and abnormal HIDA results in clinical presentations, short-term (85.7% and 84.2%) and long-term (64.9% and 60%) outcomes. Twenty-seven of the 42 children with abnormal scan results underwent interventions (21 cholecystectomy only, 4 cholecystectomy followed by sphincter of Oddi sphincterotomy, and 2 sphincterotomy only). After intervention, children with abnormal HIDA scan had better short-term prognosis (88.9% and 54.5%), but their long-term prognosis (52.2% and 85.7%) was worse than those without intervention. No clinical prognostic factor could be identified.
  
  
  CONCLUSIONS
  HIDA scan result is not a good prognostic indicator in children with suspected biliary dyskinesia. Caution should be exercised while using HIDA scan for selecting patients for surgical intervention. Focused prospective studies are needed to define biliary dyskinesia in children.
authors.affiliation: Division of Pediatric Gastroenterology, UIC College of Medicine at Peoria, Children's Hospital of Illinois at OSF St Francis Hospital, Peoria, IL, USA. smisra@pol.net
authors.forename: Sudipta
authors.initials: S
authors.lastname: Misra
mesh_terms: D001657:Biliary Dyskinesia / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome