Biliary Dyskinesia in Children and Adolescents: A Mini Review

Abstract

Introduction: While functional gallbladder disorder is a well-recognized and defined condition in adults, its pediatric analog, biliary dyskinesia, lacks uniformity in diagnosis. Yet, biliary dyskinesia is among the most common conditions resulting in cholecystectomy in youth and its frequency continues to rise. The primary aims of the current review were assess the efficacy of cholecystectomy in children diagnosed with biliary dyskinesia and the utility of cholescintigraphy in predicting outcomes. Results: All previous studies assessing outcomes in youth with biliary dyskinesia have been retrospective and therefore of low quality. There is a lack of uniformity in patient selection. Short term follow-up reveals partial response in 63.4-100% with complete resolution in 44.2-100%. Only 4 studies have reported long-term outcomes with complete symptom resolution in 44-60.7%. The published research generally indicates that the gallbladder ejection fraction (GBEF) as determined by cholescintigraphy lacks utility in predicting cholecystectomy outcome utilizing the commonly used cutoff values. There are data suggesting that more extreme cutoff values may improve the predictive value of GBEF. Conclusion: There is a lack of consensus on the symptom profile defining biliary dyskinesia in youth and current literature does not support the use of cholescintigraphy to select patients for cholecystectomy. There is a substantial portion of pediatric patients diagnosed with biliary dyskinesia who do not experience long-term benefit from cholecystectomy. Well-designed prospective studies of surgical outcomes are lacking. Increasing the uniformity in patient selection, including both symptom profiles and cholescintigraphy results, will be key in understanding the utility of cholecystectomy for this condition.

Revisión bibliográfica: abordaje quirúrgico de las patologías de la vesícula biliar en niños

“…(Bielefeldt et al, 2014) En los últimos 15 años, se han realizado 19 estudios pediátricos con tamaños de muestra de al menos 30 que informan resultados de colecistectomía en más de 2500 pacientes menores de 21 años con discinesia biliar, hay una alta tasa de mejoría de los síntomas informados en los jóvenes después de la colecistectomía por discinesia biliar. (Simon et al, 2020) A pesar de la falta de criterios de diagnóstico estandarizados y los resultados variables de la intervención quirúrgica informados en la literatura pediátrica, las colecistectomías se realizan comúnmente para niños con DB en los Estados Unidos. Se identificaron un total de 66.380 colecistectomías como diagnóstico de procedimiento primario utilizando un análisis ponderado de 2002 a 2011 en niños.…”

Laparoscopic Cholecystectomy in Children: The Experience of Two Centers Focusing on Indications and Timing in the Era of “New Technologies”

“…In the past, hemolytic disorders have represented the most frequent condition requiring LC. Pediatric cholelithiasis has been progressively increasing in the past decades and, to date, the trend is shifting towards cholelithiasis, biliary pancreatitis, cholecystitis, cholangitis, and, less commonly, biliary dyskinesia [1,[3][4][5].…”

Hypokinetic Biliary Dyskinesia in a Pediatric Patient: A Case Report

“…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].…”