Pediatric Experience with Presumed Biliary Dyskinesia

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.

Key findings:

  • 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.

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