Chronic Cholecystitis on Cholescintigraphy

• Introduction: 
• Recurrent episodes of right upper quadrant pain, usually in a middle- aged female, although occasionally in men and children, are suggestive of chronic cholecystitis. 
• The clinical diagnosis is often confirmed by detection of gallstones on sonography. 
• The standard therapy is cholecystectomy; gallbladder histopathology shows evidence of chronic inflammation. 
• On occasion, a clinician suspecting that a patient’s pain is not due to cholecystitis and that the gallstones seen are incidental may refer the patient for cholescintigraphy and a GBEF. 
• Although chronic cholecystitis classically shows delayed filling after 60 minutes, some cases will show normal gallbladder filling. 
• When CCK is administered after gallbladder filling, patients with asymptomatic cholelithiasis will have normal gallbladder contraction, whereas patients with chronic cholecystitis have a poor gallbladder response.

Chronic Acalculous Gallbladder Disease

• The acalculous form of chronic cholecystitis occurs in approximately 10% of patients with symptomatic chronic gallbladder disease. 
• It is clinically and histopathologically indistinguishable from chronic calculous cholecystitis, except that there are no gallstones. 
• This entity has been called by various names in the literature and by referring physicians, including gallbladder dyskinesia, gallbladder spasm, cystic duct syndrome, and functional gallbladder disease. 

• Patients present with recurrent right upper quadrant biliary colic, have poor gallbladder contraction, and are usually cured with cholecystectomy.
• Many investigations have found that sincalide cholescintigraphy can confirm the suspected clinical diagnosis of chronic acalculous gallbladder disease. 
• A poor GBEF predicts postcholecystectomy symptomatic relief and histopathological evidence of chronic gallbladder inflammation; a normal GBEF excludes the disease. 
• There is only one small (21 patients) randomized prospective study. In that study, 92% were cured with surgery. 
• Sincalide cholescintigraphy should be performed on an outpatient basis after a clinical evaluation has excluded other diseases. 

• It is best performed as an outpatient because acute illnesses and numerous therapeutic drugs can adversely affect gallbladder contraction and result in a false-positive study.

Sincalide Infusion Methodology

• A consensus report published by expert gastroenterologists, surgeons, and nuclear medicine physicians recommended that the 60-minute infusion method should become the standard methodology.

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