CCK analog · gallbladder imaging aid
A synthetic copy of the last eight amino acids of cholecystokinin (CCK), a gut hormone released after meals. It is a diagnostic drug, given intravenously during diagnostic procedures to make the gallbladder contract, to help collect pancreatic secretions for analysis, or to speed a barium meal through the small bowel during X-ray studies.
Cholecystokinin is released by the upper small intestine when food arrives, and it signals the gallbladder to squeeze bile into the gut and the pancreas to release digestive enzymes. Sincalide is the hormone's active C-terminal end, so it triggers the same responses on demand; per the label, the gallbladder contracts within minutes of an intravenous injection.
In a nuclear medicine scan (cholescintigraphy), a radioactive tracer first collects in the gallbladder; sincalide is then infused and the camera measures how much tracer is pushed out, the gallbladder ejection fraction. A low fraction can point to a poorly functioning gallbladder. Given together with secretin, it raises the volume and enzyme content of pancreatic juice sampled from the duodenum. It also increases intestinal movement while slowing stomach emptying.
Sincalide is an old diagnostic agent, so recent research asks how to use it consistently rather than whether it works. In a multicenter study, 60 healthy volunteers each received sincalide infusions of three different lengths on separate days; the longest, slowest infusion gave the least variable gallbladder ejection fractions and set a lower limit of normal of 38%2. An interdisciplinary consensus panel then recommended that single standardized method, while noting that a large prospective trial is still needed to show how well the scan guides care for suspected functional gallbladder disease3.
A later review notes that production problems have at times limited supply of the drug4. A 2004 review of five human studies in people on long-term intravenous nutrition found that it increased bile flow and improved bilirubin levels, but long-term benefit was unknown, and this use is not on the label1,5.
FDA-approved in 1976 as Kinevac (now Bracco Diagnostics); a second sincalide product was approved in 2022. It is indicated in adults to stimulate gallbladder contraction for imaging or bile sampling, to stimulate pancreatic secretion together with secretin, and to speed barium transit through the small bowel.
Per the FDA label, the most frequent effects are abdominal discomfort or pain and nausea. A rapid intravenous injection can cause nausea, vomiting, cramping, dizziness or flushing, which is why it is infused slowly. Warnings cover anaphylaxis and other serious allergic reactions (the product contains a sulfite), pushing small gallstones into the bile ducts, and possible preterm labor or miscarriage in pregnancy. It must not be used with intestinal obstruction.
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