298 Patterns of HIDA Scan Utilisation and Management Outcomes in Gallbladder Dysmotility: A Multicentre Cohort Study

Abstract Aim Hepatobiliary Iminodiacetic Acid (HIDA) scanning is used to evaluate gallbladder function in patients with biliary-type pain and no gallstones. An ejection fraction (EF) <35% suggests biliary dyskinesia; EF >80% indicates possible hyperkinesia, a less well-defined entity. Laparoscopic cholecystectomy (LC) may be considered in both scenarios. This study examined HIDA scan utilisation and its influence on diagnosis and management across a health board. Method A retrospective cohort study was conducted across three hospitals (2011–2023). Adult patients with biliary-type symptoms meeting Rome IV functional GI disorder criteria were included. Electronic records were reviewed for demographics, liver function tests, imaging, endoscopy, and HIDA scan results. Results Of 348 patients who underwent HIDA scanning, median age was 43 years (IQR 34–53), 83.3% were female, and 44.8% were smokers. Median BMI was 29.2 (IQR 25–33). Median symptom duration before HIDA was 19 months. EF results: 49 (14.1%) <35%, 243 (69.8%) 36–79%, and 56 (16.1%) ≥80%. Sixty-one patients (17.5%) underwent LC; 8 were listed but did not proceed. Among those operated, 47.5% had biliary dyskinesia, 37.7% had microlithiasis or sludge on EUS, and 14.8% had normal EF but persistent symptoms. Histology revealed chronic cholecystitis or cholesterosis in 93.4% of cases. EUS was performed after HIDA in 28 patients. Conclusions Gallbladder dysmotility remains underdiagnosed and inconsistently managed. HIDA scanning should be central to the diagnostic workup for acalculous biliary pain. Standardised interpretation and closer surgical-radiological collaboration are essential to improve patient selection and outcomes.