A recent study (SR Matta et al. JPGN 2018; 66: 808-10) highlights the frequency of cholecystectomies for “presumed biliary dyskinesia” in the United States.
Using a nationwide inpatient database, the authors examined the indication for cholecystectomy in the pediatric population from 2002 to 2011.
- During the study period, the authors identified 66,380 cholecystectomies in children. The leading indications were calculus cholecystitis (73.6%), biliary dyskinesia (10.8%), and chronic cholecystitis without calculus.
- The frequency of biliary dyskinesia as the indication for cholecystectomy jumped significantly during the study period, particularly the first few years: 6.6% (2002), 7.8% (2003), 9.8% (2004), 10.4% (2005 & 2006), 9.9% (2007), 11.8% (2008), 9.6% (2009), 11.9% (2010), and 10.6% (2011).
- 75% of cases were children >12 years, and 77.5% were females.
The results from the study and the way that biliary dyskinesia is controversial are reviewed in the discussion.
- A large proportion of biliary dyskinesia patients will develop symptoms suggestive of another functional GI disorder
- Long-term resolution of symptoms with cholecystectomy is highly variable after surgery and “55-85% of children with biliary dyskinesia will improve with medical management.”
- Prospective studies are lacking, but some retrospective studies have recommended using lower cut off values for ejection fraction(eg. <15-% instead of <35%); whereas, other studies have shown no correlation between ejection fraction and outcomes.
My take: Sometimes a ‘quick fix’ is not a fix at all. As this study notes, it is difficult to rely on the diagnosis of biliary dyskinesia. Many will improve without surgery and many develop divergent symptoms.
Related blog posts: