The Evaluation of Gallbladder Function by Tc-99m-DISIDA Scintigraphy in Diabetic Patients

Hwang, In Shup; Rhu, Kwang Hyun; Choi, Byung Jin; Kim, Hong Nam; Rho, Young Ho; Han, Sin; Kim, Youn Kwon; Kim, So Yon; Cho, Min Koo; Lee, Gwon Jun

Abstract

OBJECTIVES
Diabetic autonomic neuropathy is a common complication of long standing diabetes mellitus and is well known to induce the motor dysfunction of cardiovascular system, genitourinary system and diges tive system. Although many studies have done to eval uate the diabetic autonomic neuropathy, gallbladder motor function and biliary dynamic study to evaluate the change of gallbladder function in diabetic patients is relatively rare. This study was performed to measure the gall bladder ejection fraction using Tc- 99m-DISIDA with fatty meal in order to evaluate the gallbladder motor func tion in diabetic patients and to examine the usefulness of it in analyzing diabetic autonomic neuropathy.
METHODS
51 diabetic patients(males 31, females 18, mean age 57yr(39-77yr)) and 18 control subjects(males 14, females 4, mean aged 47yr(31-70yr)) without gall stone and impaired liver function were enrolled in our study. Also the diabetic patients were categorized by age, disease duration, body weight and diabetic complications such as retinopathy, peripheral neuropathy and cardiovas cular autonomic neuropathy accompanying with or not.
RESULTS
1) Median value and interquartile range of gallbladder ejection fraction(%) were 66%(48-79%) in diabetic pa tients group and 75%(64-80%) in control subjects. There was no statistically significant difference between the two groups, but the mean value of diabetic patients was slightly lower than that of control subjects. 2) There was no significant difference between the two groups in mean value of gallbladder ejection fraction in every age group(P>0.05). 3) Median value of gallbladder ejection fraction in diabetic groups with less than 10 years of duration (both under 5 years and 5 to 10 years groups) was similar to that of control subjects. However in patients whose diabetic conditions last more than 10 years, the median range of gallbladder ejection fraction was significantly lower than that of control subjects(p<0.05). 4) Median range of gallbladder ejection fraction in obese diabetic patients group was significant lower than those of control subjects and non-obese diabetic pa tients(p<0.05). 5) Median value of gallbadder was lower in diabetic patients group with complications like retinopathy, periph eral neuropathy or cardiovascular autonomic neuropathy (p<0.05) in comparison with those of control subjects and diabetic patients group without diabetic complication (p>0.05). Also seven diabetic patients whose gallbladder ejection fraction was reduced under 35% have had at least two diabetic complications.
CONCLUSION
We observed that gallbladder ejection fraction of diabetic patients was reduced compared with that of control subjects. This is due to the reduced gallbladder muscle contractility resulting from diabetic autonomic dysfunction. These results suggest that the assessment of gallbladder ejection fraction using 99m- Tc-DISIDA would be useful to diagnose diabetic auto nomic neropathy.