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. 2022 Dec;38(12):1839-1845.
doi: 10.1007/s00383-022-05241-9. Epub 2022 Sep 20.

Usefulness of hepatobiliary scintigraphy for predicting late complications in patients with choledochal cysts

Yunosuke Kawaguchi  1 , Keita Terui  2 , Shugo Komatsu  1 , Mitsuyuki Nakata  1 , Ryohei Shibata  1 , Hiroko Yoshizawa  1 , Tomoya Hirokawa  1 , Erika Nakatani  1 , Tomoro Hishiki  1
Affiliations

Usefulness of hepatobiliary scintigraphy for predicting late complications in patients with choledochal cysts

Yunosuke Kawaguchi et al. Pediatr Surg Int. 2022 Dec.

Abstract

Purpose: Hepatobiliary scintigraphy is a minimally invasive imaging method that evaluates bile flow dynamics. At our hospital, it has been performed for postoperative evaluation of patients with choledochal cysts (CC). This study evaluated the usefulness of biliary scintigraphy for predicting late complications in patients with CCs.

Methods: The study included pediatric patients with CC who underwent surgery at Chiba University Hospital from 1978 to 2020, followed by postoperative biliary scintigraphy and subsequent radiologic evaluation. The patients were divided into two groups according to the presence or absence of "biliary cholestasis" on biliary scintigraphy.

Results: The study included 108 patients, with a median age at surgery of 2 years and 11 months. The median follow-up period was 5203 days, with 11 hepatolithiasis cases and 8 cholangitis cases. No patients had cholangiocarcinoma. Twelve patients were considered to have "cholestasis" following biliary scintigraphy evaluation. There was no significant difference in the occurrence of hepatolithiasis between the cholestasis and non-cholestasis groups (p = 0.47), but cholangitis was significantly more common in the cholestasis group (p = 0.016).

Conclusion: Biliary cholestasis on postoperative hepatobiliary scintigraphy was a risk factor for cholangitis in patients with CCs. These particular patients should be monitored carefully.

Keywords: Choledochal cyst; Cholestasis; Hepatobiliary scintigraphy; Late complications.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Typical images of cholestasis and non-cholestasis on 99mTc-N-pyridoxyl-5-methyltryptophan hepatobiliary scintigraphy. With cholestasis: Upper row: Nuclide excretion is not observed beyond the Roux-en-Y anastomosis into the intestinal tract at 45 min after injection. A: Dilatation of the intrahepatic bile ducts and no nuclide excretion beyond the Roux-en-Y anastomosis. B: Dilatation of the intrahepatic bile ducts and Roux-en-Y anastomosis. Lower row: Nuclide remains within the liver; this is clearly delineated at 60 min after injection. C: Nuclide remains in the intrahepatic bile ducts and liver. D: Nuclide is retained within the right side of the liver
Fig. 2
Fig. 2
Cumulative incidence of cholangitis (a) and hepatolithiasis (b) in the cholestasis and non-cholestasis groups
See this image and copyright information in PMC

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