A pediatric surgeon’s dilemma: does cholecystectomy improve symptoms of biliary dyskinesia?

Liebe, Heather; Phillips, Ryan; Handley, Meghan; Gastañaduy, Mariella; Burton, Jeffrey; Roybal, Jessica

doi:10.1007/s00383-021-04922-1

Cited by 3 publications

(5 citation statements)

References 18 publications

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“…This lack of resolution following cholecystectomy, however, is not consistent across the literature. In a study done by Liebe et al, investigators found that at two years postcholecystectomy, 38% of patients still had resolution of abdominal pain, 43% experienced resolution of nausea, and 91% experienced resolution of their postprandial pain [7]. Similarly to those undergoing cholecystectomy for hypokinetic BD, cholecystectomy for hyperkinetic BD has not been shown to uniformly improve symptoms, with only 50% of patients in one study remaining asymptomatic at follow-up [9].…”

Section: Discussionmentioning

confidence: 99%

“…Further, 65.2% of postoperative patients reported ongoing abdominal pain, nausea, or vomiting, and, of note, all patients who underwent postoperative ERCP with sphincterotomy reported symptom relief [10]. Secondary to these varying results across the literature, there is controversy about whether cholecystectomy should be the standard of care for BD; however, more research, including clinical trials, is indicated to support these considerations [7,11].…”

Section: Discussionmentioning

confidence: 99%

“…While BD may lack a uniform diagnostic criterion in pediatrics, it is among the most common reasons for cholecystectomy in pediatric patients [5]. The most reported and well-established symptoms of BD in pediatric patients include abdominal pain (specifically the RUQ), postprandial pain, and nausea [6,7]. Between 1997 and 2010, admissions for BD in the pediatric population had a 700% increase, accounting for over 10% of cholecystectomies in children [3].…”

Section: Introductionmentioning

confidence: 99%

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Hypokinetic Biliary Dyskinesia in a Pediatric Patient: A Case Report

Klein,

Quartucio,

Miskin

2023

Cureus

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The diagnosis of biliary dyskinesia (BD) in pediatric patients lacks uniformity across the literature. BD is among the most common reasons for cholecystectomy in pediatric patients. Even still, diagnostic criteria for this disorder, including symptomatology and gallbladder ejection fraction, as well as the symptomatic relief after cholecystectomy, are inconsistent across the literature for the pediatric population. We share the case of an 18-year-old female patient who presented to our clinic for cholecystectomy for a diagnosis of BD. After 10 months of seeking a diagnosis, an eventual nuclear medicine HIDA scan revealed a biliary ejection fraction of 18%, leading her to our care. The patient underwent robotic-assisted laparoscopic cholecystectomy and tolerated the procedure well, reporting a resolution of symptoms on follow-up. The diagnosis and management of BD are complicated by the combination of vague and varied symptomatology and a lack of definitive, uniform diagnostic criteria in the pediatric population. Variability in diagnostic requirements varies between sources. While some look to the interpretation of gallbladder emptying studies, others rely on surgical outcomes. To further complicate diagnosis, some patients experience symptoms that do not correlate with their gallbladder emptying studies. The controversy extends beyond diagnosis as some studies argue against cholecystectomy as a treatment for BD, as it has been shown to not always resolve symptoms. More research should be conducted to identify and establish more consistent diagnostic criteria for BD in the pediatric population, as well as to study symptomatic improvement following cholecystectomy to establish optimal treatment for these patients. Biliary dyskinesia is a relatively common but rather inconsistent diagnosis in the pediatric population, and attention should be turned toward developing uniform and consistent diagnostic criteria in order to optimally recognize, diagnose, and treat these patients, ensuring a shorter time-to-diagnosis and improved quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypokinetic Biliary Dyskinesia in a Pediatric Patient: A Case Report

Klein,

Quartucio,

Miskin

2023

Cureus

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“…Managing incidentally diagnosed and asymptomatic gallstones in the pediatric age group poses a dilemma 10 , 30 , 31 . Long-term follow-up studies have consistently shown that only a minority of asymptomatic gallstones lead to the development of symptoms or complications which makes performing LC challenging 5 , 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Although hemolytic diseases (sickle cell anemia, hereditary spherocytosis, and thalassemia) have been identified as risk factors, the prevalence of pediatric cholecystolithiasis has increased proportionally with the recent childhood obesity epidemic 8 , 9 . The most likely cause for this increase in cholecystolithiasis in children and adolescents would be the rise in this population’s mean body mass index (BMI) 6 , 10 , 11 , with a third of children being overweight or obese, which is considered the cause of most cholecystectomies performed in pediatric patients 12 . Other reasons for cholecystolithiasis have included a cholesterol-rich diet, cephalosporins, total parenteral nutrition, sepsis, congenital heart disease, prematurity, and intestinal malabsorption 1 .…”

Section: Introductionmentioning

confidence: 99%