Long-Term Evaluation of Biliary Dyskinesia in Pediatrics

Abstract

Purpose: Biliary dyskinesia, a motility disorder of the gallbladder, causes poor emptying and pain. Quantitative cholecystokinin cholescintigraphy (QCC) identifies patients with abnormal gallbladder emptying. Ten patients (8 female, 2 male, mean age 13.8 y) with chronic right upper quadrant pain were evaluated for biliary dyskinesia using QCC. Abdominal complaints were present for a mean of 13.6 months. Epigastric pain, nausea and vomiting, food intolerance and diarrhea and/or constipation were also reported. Methods: Abdominal ultrasound, upper GI series and abdominal CT scan were done. Abnormal gallbladder ejection fractions after cholecystokinin were defined as less than 35% excretion. Results: Nine patients had normal endoscopies with one showing histological evidence of esophagitis. All patients had normal liver function. None of the patients had Helicobacter pylori. The average gallbladder ejection fraction in this group of patients was 16.97%. All 10 patients had a laparoscopic cholecystectomy and histology showed mild chronic cholycystitis in 8 of 10 patients; two had normal gallbladders. Gallstones were found surgically in 2 patients that had normal imaging studies. The mean follow up period following surgery was 23.8 months. The four patients with significant right upper quadrant pain before surgery had complete resolution of their abdominal symptoms following cholecystectomy with no other significant gastrointestinal complaints. The six patients who had continuing abdominal complaints following surgery reported right upper quadrant pain in addition to a combination of epigastric pain, vomiting and or constipation/diarrhea before surgery. Conclusions: (1) Cholecystectomy may not relieve all abdominal complaints in documented cases of biliary dyskinesia. (2) Cases of biliary dyskinesia with abdominal complaints confined to the right upper quadrant are more likely to respond to cholecystectomy. (3) Cases of biliary dyskinesia with multifocal abdominal complaints are less likely to respond completely to cholecystectomy. (4) Biliary dyskinesia may be part of a more global motility disturbance.