Evaluation of Gallbladder Contractility Using Both CCK and Milk Consecutively
Condition: Abdominal Pain
MeSH terms: Abdominal Pain
Study type: Interventional
Phase: Phase 4

Summary: 
      This study aims to combine the use of IV CCK administration followed by oral milk during a
      HIDA scan to further stimulate the gallbladder contractility and decrease the number of false
      abnormal HIDA scans and unnecessary cholecystectomies in some patients.
    

Detailed description: 
      Hepatobiliary imaging (HIDA) has an important role in the evaluation of the function and
      dynamics of the hepatobiliary system and the flow of bile to the gastrointestinal system.
      Contractility of the gallbladder is one of the functions that are uniquely evaluated using a
      HIDA scan. Poor contractility of the gallbladder can be the source of pain in many patients.
      Anatomic imaging studies like ultrasound, CT and/or MRI are usually normal in these patients.

      Contractility of the gallbladder is evaluated during a HIDA scan by intravenous injection of
      cholecystokinin (CCK) a physiologic peptide enzyme produced in the duodenum in response to
      the presence of fatty meal which causes the gallbladder to contract and the sphincter of Oddi
      to relax, thus allowing the flow of bile from the gallbladder to the duodenum. CCK is usually
      administered during a HIDA scan intravenously after filling of the gallbladder with
      radioactive tracer to simulate the action of the endogenous CCK in contracting the
      gallbladder and relaxation of the sphincter of Oddi. Gallbladder ejection fraction (GBEF) in
      response to CCK injection is calculated using special computer software program. A normal
      gallbladder ejection fraction is equal to or greater than 35%. Alternative to CCK injection,
      the patient may be administered milk as a fatty drink that should stimulate a normal
      gallbladder to contract when it reaches the duodenum approximately 15-20 minutes after oral
      administration. Thus, gallbladder contractility may be evaluated during a HIDA scan either by
      injecting CCK intravenously or oral administration of milk. Poor contractility of the
      gallbladder may result in abdominal pain usually triggered by meals. However, in many
      patients with abdominal pain and a decreased gallbladder contractility as evaluated by IV CCK
      or milk may continue to suffer from pain even after surgical removal of the gallbladder .
      This suggests that abnormally decreased GBEF after CCK or milk stimulation may represent
      false abnormal finding resulting in unnecessary cholecystectomies in some of the patients.
      There are no reports in the literature that have used both intravenous CCK stimulation and
      oral milk administration together in the same patient.

      This study aims to combine the use of IV CCK administration followed by oral milk during a
      HIDA scan to further stimulate the gallbladder contractility and decrease the number of false
      abnormal HIDA scans and unnecessary cholecystectomies in some patients.
    

Intervention name(s): Milk; CCK
Intervention type(s): Other; Biological
Intervention description(s): Milk, in the form of 8 oz. half and half, administered after CCK scan, and patient is rescanned and ejection fraction measured to determine if ejection fraction is low.; CCK is standard of care, used in HIDA scans for gallbladder function evaluation. It is given intravenously to cause the gallbladder to contract. The usual dose of CCK is 0.02mg/kg slowly over 3 minutes as per standard.
Other intervention name(s): Cholecystokinin
Intervention MeSH terms: Cholecystokinin
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic