Sincalide

Enterogastric reflux (EGR) is the reflux of duodenal contents into the stomach. A total of 157 hepatobiliary scintigraphy studies were retrospectively reviewed. Data included EGR incidence on initial reports, incidence after masked second reads, and time of EGR onset in relation to sincalide infusion. Time of EGR onset at 19–24 min after start of a 15-min sincalide infusion differed significantly from normal (p<0.0001). EGR was initially reported in 14 of 157 cases (8.9 %) but found in 38 of 157 cases on masked second reads (24.2 %). The temporal association of EGR onset with sincalide infusion identifies patients with EGR mimicking chronic cholecystitis or biliary dyskinesia. A novel classification schema was developed as a frame-work for future research, utilizing EGR onset in relation to pre-, post-, or both presincalide and postsincalide imaging as a hypothetical biomarker of clinically significant EGR.

Seven patients (3 men and 4 women, mean age 42±7 years) with recurrent episodes of epigastric or right upper quadrant pain typical of biliary colic underwent laparoscopic cholecystectomy for the diagnosis of chronic acalculous cholecystitis. The diagnosis of chronic acalculous cholecystitis was made after all patients were studied with ultrasonography and CCK cholescintigraphy. In all patients, gallbladder ultrasonography failed to demonstrate cholithiasis, and cholescintigraphy revealed decreased gallbladder ejection fractions of less than 30%. Patients with a history of acute acalculous cholecystitis were excluded. Scintigraphy was performed using a ^99mTc mebrofenin (iminodiacetic acid derivative) imaging agent, and Sincalide to reproduce the CCK biological activities. Briefly, patients were kept fasting for 4 hours before the hepatobiliary scintigraphy was initiated. A total 5 mCi of ^99mTc mebrofenin was injected intravenously after which 60 images/sec of the right upper quadrant region were acquired. Serial images every 5 minutes for the first hour were obtained with a Siemens-Diacam gamma camera (Hoffman Estates, Illinois). The gallbladder ejection fraction was then measured by administering Sincalide 1 hour after ^99mTc mebrofenin injection. Gamma rays from the gallbladder region were counted before the Sincalide injection and 30 minutes after the injection. The ejection fraction was calculated as the pre-Sincalide injection count minus the 30-minutes post-Sincalide injection gamma count divided by the pre-Sincalide injection gamma count.