Luke Ienari Sonoda PhD, FRCR, Abstract Co-Author: Nothing to Disclose

Subhadip Ghosh-Ray MBBS, Presenter: Nothing to Disclose

Korinna-Zoi Karamagkioli, Abstract Co-Author: Nothing to Disclose

Entero-gastric reflux (EGR) is often an incidental finding on 99mTc-HIDA studies, but its detection yields useful clinical information and appropriate medical and surgical intervention may be offered to the patients to relieve the symptoms. The reflux of bile and digestive fluids into the stomach is known to cause gastritis and mucosal metaplasia. This 10-year period retrospective study was carried out to determine the rate of detection as well as incidence of EGR in patients undergoing routine HIDA imaging.

422 sequential patients who underwent 99mTc-HIDA cholescintigraphy over a 10-year-period between 2004-2013 have been retrospectively reviewed. Age, sex, previous surgery, clinical indications, presence/absence of EGR and clinical reports were subjected to analysis.

Biliary dyskinesia(n=295;70%), post-surgical symptoms(n=93;22%) and sphincter of Oddi dysfunction(n=34;8%) were the three main indications for the HIDA study. 270/422(64%) patients with biliary symptoms had normal biliary function in HIDA scan. However, as many as 94/422(22%) patients had EGR. Occurrence of EGR had no statistically significant relationship with age(p=0.88), sex(p=0.79), gall bladder ejection fraction(p=0.35), time taken to visualise gall bladder(p=0.16), time taken to visualise small bowel(p=0.89) and presence/absence of previous liver/duodenogastric/pancreatic surgery(p=0.76). No significant difference was seen between a group of otherwise normal HIDA studies and a group of abnormal HIDA study(p=0.77). All the 94 cases except one did have the clinical report clearly mentioning the presence of EGR and suggestion of further clinical management.  

EGR is an easily detected common finding on routine HIDA cholescintigraphy, and may be the cause of presenting upper abdominal symptoms in patients who may have an otherwise normal HIDA study. Treatments are available for EGR so it is important to report the presence/absence of EGR. The occurrence of EGR does not appear to have any significant relationship with age and sex of patients, previous surgery with altered biliary tract anatomy, gall bladder ejection fraction, time taken to visualise small bowel and gall bladder.  

It is important to recognize and report the presence of EGR in otherwise normal HIDA study as it may explain the patients’ gastrointestinal symptoms and appropriate treatment can be initiated.

Sonoda, L, Ghosh-Ray, S, Karamagkioli, K, Entero-gastric Reflux Demonstrated in 99mTc-HIDA Scan in Patients with Biliary Symptoms  .  Radiological Society of North America 2014prod Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014prod/14000229.html