Multi-institutional analysis of long-term symptom resolution after cholecystectomy for biliary dyskinesia in children

Knott, E. Marty; Fike, Frankie B.; Gasior, Alessandra C.; Cusick, Robert A.; Brownie, Evan R.; Peter, Shawn D. St.; Azarow, Kenneth S.

doi:10.1007/s00383-013-3343-3

Cited by 17 publications

(31 citation statements)

References 14 publications

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“…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: 87%

“…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%

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

2014

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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.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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

2014

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“…Chronic abdominal pain affects 0.5%e19% of the pediatric population; accounts for 15% of visits with primary care practitioners; and is associated with missed school, interruption of daily activities, anxiety disorders, and depression [14,24e26]. Considering reported symptom improvement rates of >80% in our study and others, reported patient satisfaction rates of >85% after cholecystectomy for biliary dyskinesia [27,28], and the low risk for complications associated with elective laparoscopic cholecystectomy [7,9,11e13,21,22,28,29], we believe it is reasonable to offer cholecystectomy to patients diagnosed with biliary dyskinesia as part of their diagnostic evaluation for abdominal pain. A thorough discussion of the risks, benefits, and limited potential for symptom improvement should be had as part of a shared decision-making process with each patient and their family.…”

Section: Discussionsupporting

confidence: 59%

Prediction of symptom improvement in children with biliary dyskinesia

Mahida¹,

Sulkowski²,

Cooper³

et al. 2015

Journal of Surgical Research

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“…26 A complemen-tary approach that looked at symptom resolution in details may explain this finding, since nearly 90% of the patients studied continued to experience symptoms after cholecystectomy; however, these patients still responded that they were satisfied with the results of surgery. 27 These data fit into the larger context of our understanding of functional pain syndromes in children and 28,29 With a rising number of operations despite an apparently declining or unclear benefit, can we select candidates who are more likely to gain from surgery based on test results? The lack of well-designed trials obviously does not allow an answer.…”

Section: Cmementioning

confidence: 97%

Biliary Dyskinesia in Pediatrics

Srinath¹,

Saps²,

Bielefeldt³

2014

Pediatr Ann

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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.

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Multi-institutional analysis of long-term symptom resolution after cholecystectomy for biliary dyskinesia in children

Abstract: Short-term symptom resolution in children undergoing cholecystectomy for biliary dyskinesia is not reflective of long-term results. Neither EF, BMI % nor pain with CCK was predictive of symptom resolution. The majority of patients with ongoing complaints do not regret cholecystectomy.

Cited by 17 publications

References 14 publications

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?

Prediction of symptom improvement in children with biliary dyskinesia

Biliary Dyskinesia in Pediatrics

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