Is Biliary Scintigraphy a Reliable Diagnostic Tool For Biliary Dyskinesia in Children?

Misra, Sudipta

doi:10.1097/mcg.0b013e31820fecff

Cited by 12 publications

(35 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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].…”

Section: Discussionsupporting

confidence: 88%

“…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]. …”

Section: Discussionmentioning

confidence: 80%

“…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. These negative results led to suggestions to choose an even lower cutoff as defining criteria for BD [14, 28].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

2014

View full text Add to dashboard Cite

Background Despite lack of consensus criteria, biliary dyskinesia (BD) is an increasingly accepted pediatric diagnosis. Aims We compared patient characteristics, outcomes, and resource utilization (before and after surgery) between children with BD and symptomatic cholecystolithiasis (LITH). Methods Data from the electronic medical record were abstracted for children diagnosed with BD or LITH between December 1, 2002, and November 30, 2012, at Children’s Hospital of Pittsburgh. Results Four hundred and ten patients were identified (BD: 213 patients, LITH: 197 patients). Patients with BD had significantly lower BMI, longer symptom duration, more dyspeptic symptoms, and were more likely to present with other symptoms. Forty-one patients (13.8 %) with BD underwent cholecystectomy despite a normal gallbladder ejection fraction (GB-EF). In 32 of these, sincalide triggered pain compared to 75 of the 155 patients with low GB-EF. After surgery, patients with BD more commonly visited gastroenterology clinics and had more GI-related hospitalizations, while emergency room visits decreased in both groups. Only the nature of biliary disease independently predicted continuing pain after surgery, which in turn was the best predictor for higher resource utilization after cholecystectomy. Conclusions A large percentage of children with BD did not meet the adult diagnostic standards. Compared to those with LITH, children with BD have more widespread symptoms and continue to use more clinical resources after surgery. These findings suggest that despite its benign prognosis, BD is increasingly treated like other potentially acute gallbladder diseases, although it has the typical phenotype of FGIDs and should be treated using approaches used in such disorders.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

2014

View full text Add to dashboard Cite

show abstract

“…Previous studies approved hepatobiliary scintigraphy to be a standard way to detect GBD in pediatric patients with biliary pain, which was compatible with the results of the current case series (10)(11)(12). Gallbladder dyskinesia is diagnosed by GBEF lower than 35% (13), after CCK provocation or eating a fatty meal; moreover, the appropriate criteria for implementing hepatobiliary scan suggest using it for functional biliary pain syndrome in pediatric patients, chronic upper abdominal pain, and functional biliary pain caused by chronic acalculous biliary disease (6,14).…”

Section: Discussionsupporting

confidence: 90%

Pediatric Gallbladder Dysmotility: Not as Rare as Previously Considered; a Case Report and Review of Literature

et al. 2021

View full text Add to dashboard Cite

Introduction: Chronic abdominal pain in children is mostly functional, but in association with alarm symptoms such as recurrent vomiting, it is necessary to determine proper tests for the diagnosis of probable underlying organic problems. Case Presentation: Four patients with chronic refractory abdominal pain and nonspecific gastrointestinal symptoms presented to our tertiary pediatric center. After thorough medical and psychological investigations and hepatobiliary scintigraphy, and calculating gallbladder ejection fraction, laparoscopic cholecystectomy was performed. One year after the surgery, they were relatively symptom-free and returned to their routine life. Conclusions: Biliary tract abnormalities should be considered as a probable cause of chronic abdominal pain in children. Hepatobiliary scintigraphy can provide promising results to help to identify the underlying causes of chronic abdominal pain in association with nonspecific gastrointestinal manifestations.

show abstract

“…31 Using the above mentioned symptomatic response to the CCK agonist infusion also does not function as a prognostic tool in children. 27,32…”

Section: Cmementioning

confidence: 99%

Biliary Dyskinesia in Pediatrics

Srinath¹,

Saps²,

Bielefeldt³

2014

Pediatr Ann

View full text Add to dashboard Cite

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.

show abstract

Is Biliary Scintigraphy a Reliable Diagnostic Tool For Biliary Dyskinesia in Children?

Abstract: HIDA scan result is not a good prognostic indicator in children with suspected biliary dyskinesia. Caution should be exercised while using HIDA scan for selecting patients for surgical intervention. Focused prospective studies are needed to define biliary dyskinesia in children.

Cited by 12 publications

References 1 publication

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

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

Pediatric Gallbladder Dysmotility: Not as Rare as Previously Considered; a Case Report and Review of Literature

Biliary Dyskinesia in Pediatrics

Contact Info

Product

Resources

About