Biliary Dyskinesia in Children

Abstract

Cholecystectomy rates for biliary dyskinesia in children are rising in the United States, but not in other countries. Biliary dyskinesia is a validated functional gallbladder disorder in adults, requiring biliary colic in the diagnosis. In contrast, most studies in children require upper abdominal pain, absent gallstones on ultrasound, and an abnormal gallbladder ejection fraction (GBEF) on cholecystokinin-stimulated cholescintigraphy for diagnosis. We aimed to systematically review existing literature in biliary dyskinesia in children, determine the validity and reliability of diagnostic criteria, GBEF, and to assess outcomes following cholecystectomy. We performed a systematic review following the PRISMA checklist and searched 7 databases including PubMed, Scopus, Embase, Ovid, MEDLINE, ProQuest, Web of Science, and the Cochrane library. Bibliographies of articles were screened for additional studies. Our search terms yielded 916 articles of which 28 were included. Three articles were manually added from searched references. We reviewed 31 peer-reviewed publications, all retrospective chart reviews. There was heterogeneity in diagnostic criteria and GBEF values. Outcomes after laparoscopic cholecystectomy varied from 34% to 100% success, and there was no consensus concerning factors influencing outcomes. The observational, retrospective study designs that comprised our review limited interpretation of safety and efficacy of the investigations and treatment in biliary dyskinesia in children. Symptoms of biliary dyskinesia overlapped with functional dyspepsia. There is a need for consensus on symptoms defining biliary dyskinesia, validation of testing required for diagnosis of biliary dyskinesia, and randomized controlled trials comparing medical versus surgical management in children with upper abdominal pain.

Variability in perioperative evaluation and resource utilization in pediatric patients with suspected biliary dyskinesia: A multi-institutional retrospective cohort study

“…GB-EF, while objective compared to other diagnostic criteria, is equally flawed by variability in protocol and reproducibility, especially in pediatric patients [19,20]. The failure of this study to identify corollary relationships between GB-EF or symptom duration and outcomes, for example, further supports the need for robust, prospective data collection [21,22]. Finally, in the absence of widely accepted diagnostic and treatment algorithms for BD in the pediatric population, significant institutional variability was identified which limits the generalizability of our findings and understanding of the disease process.…”

Changing risk factors and surgical outcomes of cholecystectomy in children through the years: our 10-year experience

“…Çocuklarda kolesistektomi nedeni sıklıkla safra kesesi taşı olmakla birlikte, safra kesesi polipleri, biliyer diskinezi ve porselen kese gibi daha nadir görülen safra kesesi patolojileri de kolesistektomi gerektirebilmektedir (7) . Son yıllarda biliyer diskinezi nedeniyle yapılan kolesistektomilerin sayısında da artış olsa da, biliyer diskinezi tanısı ve kolesistektominin bu hastalarda ne kadar yarar sağlayacağı halen tartışmalıdır (8,9) . Çocukluk çağında safra kesesine ait kitlesel lezyonlar nadir görülür.…”

Biliary Tract Disease in Girls and Young Women With Rett Syndrome

“…Abdominal ultrasonography and radionuclide hepatobiliary imaging with cholecystokinin stimulation are the diagnostic procedures of choice for cholelithiasis and biliary dyskinesia, respectively, but both tests fail to detect cholecystitis (15,20,23). In one report, abdominal ultrasounds detected cholelithiasis in 88% and cholecystitis in 5% of patients, but pathology reports provided evidence that 87% of the group had cholecystitis (9).…”