Investigating the Clinical Utility of Three Protocols of Hepatobiliary Iminodiacetic Acid Scans in Gallbladder Dyskinesia

Authors

  • Alexandra Hodder Memorial University of Newfoundland https://orcid.org/0009-0000-6447-3526
  • Brandon Collins Discipline of Radiology, Memorial University of Newfoundland
  • Jack Kerr Discipline of General Surgery, Memorial University of Newfoundland
  • Alyson Decker Faculty of Medicine, Memorial University of Newfoundland
  • Jeffrey Flemming Discipline of Radiology, Memorial University of Newfoundland

Abstract

Purpose: Hepatobiliary iminodiacetic acid (HIDA) scans assess gallbladder function by measuring gallbladder ejection fraction (GBEF) to help diagnose biliary dyskinesia, a functional disorder causing biliary-type pain with no structural abnormalities on ultrasound. Various HIDA protocols use different stimulants and imaging times, but their comparative clinical utility and impact on patient outcomes remain unclear. This study aimed to compare GBEF values, surgical intervention rates, pathology, and symptom resolution across three common HIDA protocols.

Methods: A retrospective review of 525 patients with abdominal pain, normal biliary ultrasound, and abnormal HIDA scans (GBEF ≤40% or radiologist opinion) from 2018–2022 was performed. Protocol 1 used intravenous sincalide with imaging at 30 minutes; Protocols 2 and 3 used oral stimulants (Ensure® and fatty meal) with imaging at 60 minutes. Demographic and clinical variables were compared using ANOVA, Welch’s ANOVA, Chi-square, and Fisher’s exact tests.

Results: Protocol 1 included 318 patients (60.6%), Protocol 2 had 175 (33.3%), and Protocol 3 had 32 (6.1%). Protocol 1 showed significantly lower mean GBEF values (60.7% ± 30.6) compared to Protocol 2 (74.9% ± 19.0; p<0.001), with greater variability. Cholecystectomy rates were higher in Protocol 1 (21.4%) versus Protocol 2 (9.7%; p=0.004). Symptom resolution post-surgery was similar across groups (~86%; p=0.839), as was final pathology (p=0.485).

Conclusions: Despite protocol differences affecting GBEF values and surgery rates, patient outcomes were comparable. Protocol 1 remains the gold standard, but Protocols 2 and 3 could serve as reasonable alternatives; prospective studies with standardized imaging times are needed to validate these findings.

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Published

2026-07-31

How to Cite

Hodder, A., Collins, B., Kerr, J., Decker, A., & Flemming, J. (2026). Investigating the Clinical Utility of Three Protocols of Hepatobiliary Iminodiacetic Acid Scans in Gallbladder Dyskinesia. Lithos - The Memorial University Medical Journal, 3(2), 7–13. Retrieved from https://journals.library.mun.ca/index.php/MUNMJ/article/view/2912

Issue

Vol. 3 No. 2 (2026): Vol. 3 No. 2 (2026)

Section

Original Research

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