Gallbladder Dyskinesia

Presti, Michael; Elwing, Jill E.; Sayuk, Gregory S.

doi:10.14423/smj.0000000000001466

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…Due to the oftentimes non-surgical management for other benign functional illnesses, such as dyspepsia, irritable bowel syndrome, or gastroparesis, some argue that BD should be managed similarly [13]. Although the complexities in diagnosis and treatment for BD may hinder strong randomized controlled studies from being performed, these are necessitated to provide a clearer, evidence-based management of this disorder and consider all arms of treatment [14].…”

Section: Discussionmentioning

confidence: 99%

Hypokinetic Biliary Dyskinesia in a Pediatric Patient: A Case Report

Klein,

Quartucio,

Miskin

2023

Cureus

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The diagnosis of biliary dyskinesia (BD) in pediatric patients lacks uniformity across the literature. BD is among the most common reasons for cholecystectomy in pediatric patients. Even still, diagnostic criteria for this disorder, including symptomatology and gallbladder ejection fraction, as well as the symptomatic relief after cholecystectomy, are inconsistent across the literature for the pediatric population. We share the case of an 18-year-old female patient who presented to our clinic for cholecystectomy for a diagnosis of BD. After 10 months of seeking a diagnosis, an eventual nuclear medicine HIDA scan revealed a biliary ejection fraction of 18%, leading her to our care. The patient underwent robotic-assisted laparoscopic cholecystectomy and tolerated the procedure well, reporting a resolution of symptoms on follow-up. The diagnosis and management of BD are complicated by the combination of vague and varied symptomatology and a lack of definitive, uniform diagnostic criteria in the pediatric population. Variability in diagnostic requirements varies between sources. While some look to the interpretation of gallbladder emptying studies, others rely on surgical outcomes. To further complicate diagnosis, some patients experience symptoms that do not correlate with their gallbladder emptying studies. The controversy extends beyond diagnosis as some studies argue against cholecystectomy as a treatment for BD, as it has been shown to not always resolve symptoms. More research should be conducted to identify and establish more consistent diagnostic criteria for BD in the pediatric population, as well as to study symptomatic improvement following cholecystectomy to establish optimal treatment for these patients. Biliary dyskinesia is a relatively common but rather inconsistent diagnosis in the pediatric population, and attention should be turned toward developing uniform and consistent diagnostic criteria in order to optimally recognize, diagnose, and treat these patients, ensuring a shorter time-to-diagnosis and improved quality of life.

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Section: Discussionmentioning

confidence: 99%

Hypokinetic Biliary Dyskinesia in a Pediatric Patient: A Case Report

Klein,

Quartucio,

Miskin

2023

Cureus

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Programa de Recuperación Quirúrgica Mejorada. Colecistectomía Segura

Noyola Villalobos,

Ortiz Higareda,

Chapa Azuela

et al. 2024

Cirujano General

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The Management of Dysfunctional Gallbladder Disease and the Role of Laparoscopic Cholecystectomy on Symptom Improvement: A Retrospective Cohort Study

Abuahmed,

Wuheb,

Eskandar

et al. 2024

Cureus

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BackgroundBiliary dyskinesia (BD) is a disorder characterised by abdominal pain of biliary origin (i.e., sudden steady pain at the right upper quadrant of the abdomen or the epigastrium, the absence of gallstones on ultrasound (US)), and a decreased gallbladder ejection fraction (GBEF) on a cholecystokinin-cholescintigraphy hepatobiliary iminodiacetic acid (CCK-HIDA) scan. Patients experiencing symptoms suggestive of biliary obstruction, but lacking gallstones, yet exhibiting abnormal gallbladder emptying, may find therapeutic benefit from laparoscopic cholecystectomy. Common symptoms include recurrent, intense, and enduring pain, often exacerbated by fatty food consumption, localised in the upper right quadrant or epigastric region. This pain may radiate to the back or shoulder, persisting for at least 30 minutes but not exceeding several hours, and it is sometimes accompanied by nausea and vomiting. Abnormal gallbladder emptying is typically indicated by a GBEF below 35% on cholescintigraphy following cholecystokinin administration. ObjectiveThis study represents a single-centric review focusing on 88 patients over a five-year period who presented with features of dysfunctional gallbladder and underwent cholescintigraphy. The primary aim was to identify whether there is any role for laparoscopic cholecystectomy in symptom improvement among these patients. MethodsThis was a retrospective cohort study involving data collection using electronic medical records. Eightyeight patients who underwent the HIDA scan between January 2019 and December 2023 at Wirral University Teaching Hospital NHS Foundation Trust (WUTH) were identified and separated into two groups, either hypofunctioning gallbladder (EF<35% ) or hyperfunctioning gallbladder (EF>80%). Normal HIDA scan patients (EF between 35%-80%) were excluded. The frequency of laparoscopic cholecystectomy and subsequent symptom improvement were recorded. ResultsFifty-one patients were diagnosed with gallbladder dyskinesia (BD). Of these, 36 patients (30 females, mean age 43) were diagnosed with hypofunctional gallbladder (EF<35%), where 17 patients underwent laparoscopic cholecystectomy, resulting in symptom improvement in 10 patients (58.8%). Conversely, 15 patients were diagnosed with hyperfunctional gallbladder (13 females, mean age 48.6). Only two patients (13%) underwent laparoscopic cholecystectomy with 100% symptom improvement in both patients. ConclusionsIn conclusion, our retrospective study highlights the significance of the HIDA scan in identifying gallbladder hypofunction among patients presenting with biliary symptoms. The findings establish the efficacy of laparoscopic cholecystectomy as a management approach, with a notable proportion of patients experiencing symptom improvement (58.8%). These results contribute to our understanding of biliary dysfunction management and emphasise the importance of individualised treatment strategies for optimal patient outcomes. Further, randomised controlled trials (RCTs) are warranted to validate these findings and exp...

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Gallbladder Dyskinesia

Cited by 3 publications

References 26 publications

Hypokinetic Biliary Dyskinesia in a Pediatric Patient: A Case Report

Hypokinetic Biliary Dyskinesia in a Pediatric Patient: A Case Report

Programa de Recuperación Quirúrgica Mejorada. Colecistectomía Segura

The Management of Dysfunctional Gallbladder Disease and the Role of Laparoscopic Cholecystectomy on Symptom Improvement: A Retrospective Cohort Study

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