Hepatobiliary Scan for Assessing Disease Severity in Patients With Cholelithiasis

OBJECTIVE: To evaluate the role of a hepatobiliary scan for predicting the severity of cholecystitis and the difficulty of laparoscopic cholecystectomy. DESIGN: Prospective study. SETTING: Department of surgery at a tertiary university hospital. PATIENTS: From July 1, 2004, through June 30, 2007, data from 941 patients who underwent a preoperative hepatobiliary scan before laparoscopic cholecystectomy were prospectively recorded. MAIN OUTCOME MEASURES: Prediction of the severity of cholecystitis. RESULTS: The overall predictive value of the gallbladder ejection fraction (GBEF) for predicting acute cholecystitis was 82.9% (P < .001), and the sensitivity and specificity of the GBEF at a set point of 30.0% were 92.1% and 61.6%, respectively. The mean (SD) severity of the cholecystitis score and the difficulty in performing laparoscopic cholecystectomy scores in the patients with gallbladder nonvisualization or a GBEF less than 30.0% (2.9 [2.5] and 0.5 [0.9], respectively) were significantly higher than those for the patients with a GBEF of 30.0% or higher (0.5 [1.1] and 0.3 [0.6]; P < .001 and P = .01, respectively). Moreover, the patients with gallbladder nonvisualization or a GBEF less than 30.0% experienced higher rates of complication after laparoscopic cholecystectomy than did the patients with a GBEF of 30.0% or higher (6.3% vs 2.6%; P = .006). CONCLUSIONS: A hepatobiliary scan is useful for predicting the severity of cholecystitis, and a difficult laparoscopic cholecystectomy is predicted for patients with gallbladder nonvisualization or a GBEF less than 30.0%.