Assessment of the reproducibility of quantitative hepatobiliary scintigraphy (QHBS) in patients with sphincter of Oddi dysfunction (SOD) – Inappropriate method or intermittent disease?

Introduction: Although QHBS has been suggested as a promising screening method in pts with suspected SOD, it was recently claimed that QHBS has poor reproducibility. The aim of the present study was to assess the reproducibility of QHBS in cholecystectomized patients.

Methods: 28 pts with suspected SOD underwent QHBS evaluation on two separate occasions. On the basis of the ERCP and clinical data, 10 pts were classified as having SOD of biliary type I (SO stenosis), and the remaining 18 as having SOD of biliary type II or III (SO dyskinesia). During the same period, 12 asymptomatic cholecystectomized individuals (controls) were also recruited to undergo QHBS evaluation on two separate occasions. QHBS was performed with our standard method in all cases.

Results: In controls, the QHBS parameters were highly reproducible. The specificity was 83%, when a true-negative was defined as both QHBS examinations completely negative. In the SO stenosis group all had both QHBS examinations abnormal; therefore, the specificity was 100%. In pts in the SO dyskinesia group, the QHBS parameters were distinctly variable and poorly reproducible. The correlation was excellent and significant when the first and second QHBS results were compared in the controls and SO stenosis group but poor after the data were supplemented with those on the SO dyskinesia group.

Conclusion: Our results suggest the poor reproducibility of QHBS in pts with SO dyskinesia, but not in pts with SO stenosis or controls. This phenomenon might indicate an intermittent disease manifestation in SO dyskinesia rather than a methodological problem of QHBS.