Biliary Dyskinesia in Pediatrics

Abstract

Biliary dyskinesia (BD) is a diagnosis that is being made increasingly in children. It is defined by abdominal pain thought to be biliary in nature based on location and character; a completely normal gallbladder on imaging tests, typically ultrasound; and decreased gallbladder contraction in response to a pharmacological stimulus. Unlike other functional gastrointestinal disorders (FGIDs) that are treated with medications, behavioral therapy, and/or dietary modification, current clinical practice has accepted cholecystectomy as the treatment of choice for BD, which now accounts for up to 50% of cholecystectomies in children. Although well-designed trials are missing, accumulating evidence argues against such an approach. First, BD is by definition a benign disorder without risk of truly relevant complications. Second, despite reportedly high rates of satisfaction with postoperative outcomes, most children continue to experience symptoms. Lastly, limited long-term studies have demonstrated comparable benefit of operative and conservative therapy. To summarize, BD should be seen as a more localized manifestation of functional abdominal pain, which may improve over time independent of the type of therapy chosen. Despite the widespread adoption of minimally invasive surgery in pediatrics, a different risk-benefit ratio favors conservative treatment for this benign disorder.

Prediction of symptom improvement in children with biliary dyskinesia

“…In our analyses, the PPV of each test for symptom improvement or resolution remained near 80% regardless of the EF cutoff level used to define biliary dyskinesia. Consistent with the variable value of EF in the literature, the Rome III diagnostic criteria for biliary dyskinesia are based on clinical characteristics of the patient and do not include EF [14].…”

Chronic Acalculous Cholecystitis in Children With Biliary Symptoms

“…The majority of existing pediatric studies for biliary dyskinesia have evaluated the outcomes in subset of patients who underwent cholecystectomy for biliary dyskinesia (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Although most of the studies did record histopathology of GB specimens, the diagnosis of biliary dyskinesia was largely based on clinical, laboratory, and imaging criteria, and not histology.…”

Decision-making patterns in managing children with suspected biliary dyskinesia

“…The number of children undergoing cholecystectomy has increased in the past decade[30]. Despite the safety of laparoscopic cholecystectomy in children, a different risk-benefit ratio should be considered in children with suspected FGBD[31]. Figure 4 demonstrates the algorithm for the best practice management approach in children with suspected FGBD based on our literature review.…”