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OBJECTIVES: Cholecystokinin-stimulated hepatobiliary scintigraphy (CCK-HBS) is a noninvasive method reported to be highly accurate in the diagnosis of sphincter of Oddi dysfunction. Our primary aim was to assess the specificity of CCK-HBS by evaluating its ability to exclude disease in 20 asymptomatic postcholecystectomy individuals. Secondary aims were to assess the interobserver reliability in scoring the CCK-HBS examinations between three blinded observers and to assess reproducibility of CCK-HBS repeated in the same individuals, METHODS: Twenty asymptomatic postcholecystectomy individuals with normal liver serum chemistries underwent CCK-HBS on two separate occasions. Three nuclear medicine specialists read each CCK-HBS study in a blinded fashion. RESULTS: There was good agreement between the three observers reading the same scans for both the first scan (κ = 0.554) and the second scan (κ = 0.507), There was poor agreement between the first and second scans on the same patient, read by the same nuclear medicine specialist (κ = 0.062-0.385). The overall specificity of the CCK-HBS score was 77.5%; however, the specificity was only 60% when a true negative was defined as two negative CCK-HBS examinations. CONCLUSIONS: Quantitative CCK-HBS is of poor specificity in asymptomatic postcholecystectomy individuals. Hence, it is of questionable value in excluding sphincter of Oddi dysfunction in patients suspected to suffer from this disorder. [ABSTRACT FROM AUTHOR]

An abstract to the article "A Blinded, Stratified, Randomized Clinical Trial Comparing Magnetic Resonance Cholangiopancreatography (MRCP) to Endoscopic Ultrasound (EUS) for the Evaluation of Common Bile Duct Stones (CBDS)," by Benoit C. Pineau, Vaman S. Jakribettuu, and colleagues is presented.

The purpose of this study was to determine the sensitivity and specificity of CT colonography (CTC) to detect colorectal polyps and cancer compared with conventional colonoscopy. In this investigation, 300 patients (97% male; mean age 62.6 yr) at a university-affiliated Veterans Affair hospital were recruited to undergo CTC 2–3 h before a clinically indicated conventional colonoscopy. Colonic lavage was achieved with 10 oz of magnesium citrate and 4 L of a polyethylene glycol electrolyte lavage solution; colonic distention was performed using hand-bulb insufflation of air. Volumetric data were acquired under 60 s using a single-slice spiral CT scan of the abdomen and pelvis in the supine position, and repeated in the prone position. Lesion size at CTC was determined by measuring the largest diameter with computed calipers; polyp size at conventional colonoscopy was estimated in reference to open biopsy forceps.The study population consisted of 204 subjects undergoing evaluation of gastrointestinal symptoms and 96 for colorectal neoplasia screening. Conventional colonoscopy found a total of 532 lesions, including eight cancers. The ability of CTC to identify individual lesions, as well as patients with lesions, was proportional to the lesion size. For individual lesion detection, the overall sensitivity of CTC was 69.7%; however, the sensitivity for lesions 5–9.9 mm and those 10 mm or greater were 80.1% and 90%, respectively (82% and 94% respectively for adenomas). All eight cancers were detected. For detecting lesions of any size, the sensitivity and specificity were 90.1 and 72% respectively. CT colonography was more accurate in identifying patients with lesions 5–9.9 mm and those with lesions ≥10 mm with sensitivities of 93 and 100% respectively. The results were comparable between asymptomatic and symptomatic patients. CT colonography demonstrated 185 false-positive lesions in 113 patients, 24 ≥1 cm and 97 of 5–9.9 mm in size; it failed to detect eight polyps of size 10 mm or greater and 28 polyps measuring 5–9.9 mm. Inadequate bowel preparation appeared to be a greater factor than poor colonic distention.The authors conclude that CTC has excellent sensitivity for clinically important polyps of 10 mm or greater and can reliably detect colorectal cancers equally well in symptomatic and asymptomatic patients. [Copyright &y& Elsevier]

An abstract of the article "Prevalence of Extracolonic Findings at Virtual Colonoscopy," by Benoit C. Pineau, Sandi Manus, Kim Phillips, G. John Chen, Claudia Mikulaninec, James P. Han, and David J. Vining is presented.

An abstract to the article "Follicular Center Cell Lymphoma of the Ampulla of Vater Presenting With Ascending Cholangitis," by Luis F. Lara, A. Jullian Garvin, Mark J. Pettenati and Benoit C. Pineau is presented.