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 cut-off values. There are data suggesting that more extreme cut-off 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.
Highlights
While functional gallbladder disorder is a well-recognized and defined condition in adults, its pediatric analog, biliary dyskinesia, lacks uniformity in diagnosis
There is a lack of consensus regarding the symptom profile defining biliary dyskinesia
There are a number of important issues that need to be resolved before continuing with the increasing rate of cholecystectomy in children diagnosed with biliary dyskinesia
Summary
While functional gallbladder disorder is a well-recognized and defined condition in adults, its pediatric analog, biliary dyskinesia, lacks uniformity in diagnosis. Biliary dyskinesia is among the most common conditions resulting in cholecystectomy in youth and its frequency continues to rise. While Rome IV does not recognize this disorder in children and adolescents, biliary dyskinesia is a term that has traditionally been used to define an analogous, less well-defined, condition in pediatrics. Once biliary dyskinesia is diagnosed, the usual treatment is cholecystectomy as there is no accepted medical treatment specific to altering gallbladder function [2, 3]. Biliary dyskinesia is among the most common conditions resulting in cholecystectomy in children and adolescents [11,12,13]. It remains difficult for physicians to predict which patients will achieve long-term benefits from surgery
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