A comparison of cholecystectomy and observation in children with biliary dyskinesia

Biliary Dyskinesia and Symptomatic Gallstone Disease in Children: Two Sides of the Same Coin?

“…However, response rates decrease over time and are quite similar to our results [14, 28, 45, 52–54]. Importantly, recent evidence suggests that despite high rates of symptomatic improvement soon after surgery, conservative therapy may be equally effective if not superior to cholecystectomy, when children were followed over longer periods of time [12, 14]. Others have demonstrated that the two most commonly used diagnostic criteria, a low GB-EF or pain triggered by sincalide infusion, did not predict postoperative outcomes [45, 48, 52], which is certainly consistent with our findings based on the largest cohort examined as of yet.…”

“…Despite these obvious caveats, the correspondence between symptom persistence or recurrence and continuing use of clinical services indirectly supports the validity of our findings. Lastly, the lack of any association between mood disorders and a FGID, in this case BD, has previously been reported in a smaller study [12] and is unusual, as such disorders commonly coexist in pediatric patients with functional illnesses [63]. We see these negative results as a consequence of our retrospective design, which relies on listed and clinically manifest mood disorders rather than the systematic assessment of anxiety and/or depression.…”

“…The relatively high number of children receiving only one type of or even no medical treatment argues against this interpretation as being valid for a significant number of cases. In addition, only six patients were treated conservatively, which is a smaller number than previously reported in other studies and suggests a relatively low threshold for surgical referral and intervention [12, 19, 21, 45]. …”

“…While the results favored cholecystectomy, the control group did not receive any active therapy and did not show any improvement, a highly unusual finding in functional disorders [13]. The results also differ from reported outcomes in BD, which are more variable with decreasing success rates after longer follow-up time and which include response rates exceeding 50 % in patients who did not undergo surgery [12, 14–28]. …”

“…The introduction of functional gallbladder testing and acceptance of BD in adults led to an apparent shift in pediatric practice. Even though BD has not been included in the list of pediatric FGIDs catalogued by the Rome III consensus group [7], the diagnosis is made increasingly often and BD now accounts for up to half of the cholecystectomies in pediatric centers [8–12]. Yet, only one study has evaluated this approach in a randomized controlled trial that enrolled adults only [13].…”