diagnostic role of hepatobiliary scintigraphy in bile leak evaluation: a systematic review and meta-analysis

Objective(s): this study aimed to systematically evaluate the diagnostic accuracy of hepatobiliary scintigraphy (hbs) for detecting bile leaks in post-traumatic and postoperative settings, given the increasing incidence of such complications following hepatobiliary surgeries and abdominal trauma.methods: a systematic review and meta-analysis were conducted in accordance with the prisma guidelines. literature searches of pubmed, embase, and scopus databases were performed through june 19, 2025. studies were included if they assessed patients with suspected bile leak using hbs and reported sufficient data to construct diagnostic contingency tables. the quality of included studies was assessed using the quadas-2 tool. pooled sensitivity, specificity, positive predictive value (ppv), negative predictive value (npv), and overall diagnostic accuracy were calculated. subgroup analyses evaluated diagnostic performance across clinical contexts such as post-trauma, liver transplant/resection, and cholecystectomy.results: sixteen studies with 673 patients were included. the pooled sensitivity and specificity of hbs were 0.882 (95% ci: 0.81–0.93) and 0.93 (95% ci: 0.83–0.97), respectively. the pooled ppv was 0.874 and npv was 0.965, with an area under the sroc curve of 0.94, indicating excellent diagnostic performance. subgroup analyses showed the highest accuracy in trauma patients, while specificity varied more in postoperative settings, particularly after liver transplant or resection.conclusion: hbs is a highly sensitive and reliable imaging modality for ruling out bile leaks. while variability in specificity warrants cautious interpretation in complex surgical cases, hbs should be considered a valuable first-line, non-invasive diagnostic tool in evaluating suspected bile leaks.