Comparison of the dynamics of bile emptying by quantitative hepatobiliary scintigraphy before and after cholecystectomy in patients with uncomplicated gallstone disease

Purpose: Quantitative hepatobiliary scintigraphy, a noninvasive method freq uently used to diagnose several biliary tract disorders, shows abnormalitie s in bile secretion and outflow. It is well known that there are wide varia tions in the normal pattern of bile emptying, but the effect of cholecystec tomy on the bile flow has not yet been investigated. The goal of the curren t study was to examine the dynamics and normal variations of bile flow by q uantitative hepatobiliary scintigraphy before and after cholecystectomy in a group of patients with uncomplicated gallstone disease. Methods: Twenty patients were evaluated before and after cholecystectomy th rough cholecystokinin octapeptide-augmented quantitative hepatobiliary scin tigraphy, and quantitative parameters of bile emptying (T-max: time to peak activity, T-1/2: half-emptying time before and after cholecystokinin octap eptide and duodenum appearance time) were determined and then compared. Results: Before operation, the bile outflow displayed wide variations, with a moderately delayed common bile duct emptying time in some patients. Afte r cholecystectomy, the T-1/2 of the common bile duct decreased significantl y when compared with the preoperative status, with only minor patient-to-pa tient variation, indicating uniformly faster bile emptying (common bile duc t T-1/2 before and after operation: 30.5 +/- 14.8 and 18.8 +/- 2.6 min, res pectively). Cholecystokinin octapeptide administration caused rapid bile ou tflow from the common bile duct, with a significant decrease in the T-1/2 p arameters before and after cholecystectomy. Conclusions: In patients with their gallbladders in situ, the bile emptying rate showed wide variations and may be moderately slow without distal comm on bile duct obstruction. After cholecystectomy, the rate of bile emptying accelerated and showed only minor variations, thereby increasing the sensit ivity of quantitative hepatobiliary scintigraphy for showing partial biliar y obstruction.