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  More Justification for Having the CCK-HIDA Scan

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Author Topic:   More Justification for Having the CCK-HIDA Scan
LindaB
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Posts: 647
Registered: Jan 99

posted 03-24-1999 09:09 PM     Click Here to See the Profile for LindaB     Edit/Delete Message Reply w/Quote
Charlie just sent me this info via email. Now let's see if my cut and paste will work.

Biliary Dyskinesia:

A Study Of More Than 200 Patients and Review of the Literature

Anthony J. Canfield, M.D, Stephen P. Hetz, M.D., F.A.C.S., John R Schriever, M.D., Hubert T Servis M.D., Trent L. Hovenga, M.D., Paul T Cirangle, M.D., Brian S. Burlingame, M.D.

The diagnosis and treatment of biliary dyskinesia, defined as symptoms of biliary colic in the absence of gallstones, remains controversial and has been the subject of several previous retrospective reviews. The diagnosis and treatment of biliary dyskinesia based on the CCK-HIDA scan, and the outcome with cholecystectomy for billary dyskinesia, are reviewed. We add more than 200 cases of cholecystectomy for biliary dyskinesia, and compare our results with those of previous reports. We retrospectively reviewed 295 patients with biliary dyskinesia who underwent cholecystectomy at three military hospitals between 1988 and 1995. All patients had symptoms consistent with biliary colic and preoperative evaluations that revealed no evidence of cholelithiasis. Pathology specimens were reviewed for cholelithiasis and pathologic changes. Data were retrieved by chart review and clinic evaluation of new patients. Individual follow-up of each patient was attempted. Follow-up was achieved in 218 of the 295 patients for a rate of 74%. The mean duration of follow-up was 506 days with a range of 22 days to 6 years. Two hundred patients (92%) had CCK-HIDA scans with an ejection fraction (EF) <50%. Eighteen patients (8%) had an EF >50% but did have reproduction of their symptoms with CCK injection. In the group with an EF <50%, 94.5% were improved or cured with cholecystectomy. In the group with an EF >50% and pain reproduction, the improved or cured rate was 83.4%. CCK-HIDA scans are useful for diagnosing biliary dyskinesia and predicting improvement after cholecystectomy. Patients presenting with biliary dyskinesia and an EF <50% on CCK-HIDA scan have 94% improvement or resolution of their symptoms after cholecystectorny. CCK-HIDA scans should be employed early in the evaluation of billary colic with no evidence of cholelithiasis (i.e., with a normal ultrasound scan). When test results are abnormal, cholecystectomy should be performed, since the results in this setting approach those of cholecystectomy for stone disease (>90% cured/improved). In the current climate of cost containment, these excellent results would obviate the need for extensive and expensive medical testing before surgical therapy is recommended. (J GASTROINTEST SURG 1998;2:443-448.)

Now I just have to read it closely and figure out what the heck they're saying!


[This message has been edited by LindaB (edited 03-24-99).]

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charlie
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posted 03-24-1999 09:30 PM     Click Here to See the Profile for charlie   Click Here to Email charlie     Edit/Delete Message Reply w/Quote
what it says linda is

"STICK YOUR HEAD BETWEEN YOUR LEGGS AND KISS YOUR GALLBLADDER GOODBY" HA HA ,
thanks linda for posting that, mine did not come out,i tried posting it to,
are you comming to our pool party?ha ha,
if you do bring your gallbladder,ha ha
sass has a killer chocolate cake,and kathy is going to bring her stones boy am i in a stupid mood tonight
thanks linda
charlie

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LindaB
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Posts: 647
Registered: Jan 99

posted 03-25-1999 08:25 AM     Click Here to See the Profile for LindaB     Edit/Delete Message Reply w/Quote
Calling Dr. Kildare, Marcus Welby, or anyone else with the medical background to translate this into language for the rest of us. We need to be able to understand this so we can effectively communicate the info when our doctors tell us we don't need the CCK-HIDA scan, or that our symptoms are not "typical", or that it's IBS so live with it.

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heykate
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Posts: 556
Registered: Jan 99

posted 03-25-1999 09:01 AM     Click Here to See the Profile for heykate   Click Here to Email heykate     Edit/Delete Message Reply w/Quote
I've just put my brain on and read through the above again. It is MOST interesting (Charlie, are you sure this isn't put out as an ad for the HIDAscan/CCK machine in the physicians mags?). I think what it is saying is (and I'm not entirely sure, since I am not bi-lingual) that when there are pain and symptoms consistent with gallbladder dysfunction, and if the ultrasound appears normal, then it is ALWAYS prudent to continue to the HIDAscan/CCK as a method of detecting biliary dyskinesia (bad, bad gallbladder). If the HIDAscan/CCK shows a less than 50% flow rate, their study found that after the cholecystectomy (removal of the bad, bad gallbladder) the symptoms were cured at a rate of 94% (94 people out of 100 became symptom-free). At the end of the article, they recommend that because of these findings, when there are symptoms which indicate a bad, bad gallbladder (such as Charlie's and mine - and LindaB's the fighter), then after the normal ultrasound, the doctors should NOT go on to other intestinal tests first, but should immediately proceed to the HIDAscan/CCK. I believe that the key here are the symptoms. Just because an ultrasound does NOT show stones, it does not mean that, especially in those with symptoms consistent with GB disease (biliary dyskinesia) the gallbladder is NOT diseased and does NOT need to be removed. In other words, this article pretty much makes Charlie's point!

Have we mentioned that we missed you, Charlie??

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charlie
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posted 03-25-1999 02:45 PM     Click Here to See the Profile for charlie   Click Here to Email charlie     Edit/Delete Message Reply w/Quote
hi kathy,and linda
no that is not a add pushing the hida/cck scan,what i did was go into msn net type in hida scan and came up with that and there are others to,
i think it is just what we have been saying all the time,as in my case remember i had 2 ct's and 2 ultra sounds they both came up with nothing,BUT before that i had all of those great ibs test done,all they had to do was listen to me in the first visit about my symptoms they were g/b related in the fall of 97, but nooooo, they had to do there thing
so when do i get the hida/cck feb 99 that was the last and final test,it should have been the third test after ct/ultra sounds,you know its funny now that i think of it,check it out! why on earth would they give me 2 ultra sounds and 2 cat scans! on my g/b i have the ct scan x rays here with me i never brought them back, my point is why double up those test if they show nothing
go right for the hida/cck.
think of it another way,in march of 98 i was told that i have ibs and my g/b is just fine right down to the blood work, so i had to suffer even more as my g/b was heading south
for a year almost to the month,in twice as bad of shape then in 98,all bacause someone may not know about the hida/cck test,that is b/s, how do i get back that year of suffering,
it may not be the answer for ibs, but just how many people have a g/b problem and not ibs because of this? my bowels are still screw up but all the bad symptoms are 100% gone!! that last part is for you linda,kathy,and dave,so even if having my g/b out give me a case of the s--ts, i can handle that
why did write such a long post
see ya
charles de galled

[This message has been edited by charlie (edited 03-25-99).]

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charlie
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posted 03-25-1999 05:37 PM     Click Here to See the Profile for charlie   Click Here to Email charlie     Edit/Delete Message Reply w/Quote
oops

IP:

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