Long-term results of cholecystectomy for biliary dyskinesia: outcomes and resource utilization

Cairo, Sarah B.; Ventro, George; Sandoval, Ellene; Rothstein, David H.

doi:10.1016/j.jss.2018.04.044

Cited by 6 publications

(5 citation statements)

References 34 publications

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“…Similarly to those undergoing cholecystectomy for hypokinetic BD, cholecystectomy for hyperkinetic BD has not been shown to uniformly improve symptoms, with only 50% of patients in one study remaining asymptomatic at follow-up [9]. In one study by Cairo et al, investigators found that patients were undergoing significant diagnostic workup postoperatively for persistent pain, including abdominal ultrasound, esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound, magnetic resonance cholangiopancreatography (MRCP), and colonoscopy [10]. Further, 65.2% of postoperative patients reported ongoing abdominal pain, nausea, or vomiting, and, of note, all patients who underwent postoperative ERCP with sphincterotomy reported symptom relief [10].…”

Section: Discussionmentioning

confidence: 99%

“…In one study by Cairo et al, investigators found that patients were undergoing significant diagnostic workup postoperatively for persistent pain, including abdominal ultrasound, esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound, magnetic resonance cholangiopancreatography (MRCP), and colonoscopy [10]. Further, 65.2% of postoperative patients reported ongoing abdominal pain, nausea, or vomiting, and, of note, all patients who underwent postoperative ERCP with sphincterotomy reported symptom relief [10]. Secondary to these varying results across the literature, there is controversy about whether cholecystectomy should be the standard of care for BD; however, more research, including clinical trials, is indicated to support these considerations [7,11].…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Hypokinetic Biliary Dyskinesia in a Pediatric Patient: A Case Report

Klein,

Quartucio,

Miskin

2023

Cureus

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“…Also at odds with Rome criteria, 61% reported daily pain (15). An additional 1,178 pediatric patients have been reported in the literature since the previous systematic review and report similar variability (14,(16)(17)(18). In the largest of these studies, a recent multicenter study involving 16 institutions and 678 patients, Cairo et al reported RUQ pain in 76.7% and postprandial pain in 71.4% of pediatric patients diagnosed with biliary dyskinesia (16).…”

Section: Symptomsmentioning

confidence: 97%

“…In children and adolescents, cholescintigraphy to determine GBEF is generally performed to diagnose biliary dyskinesia, but it is not clear to what degree it drives patient selection for, or predicts patient response to, cholecystectomy. Seven studies assessing GBEF at cut-offs most commonly utilized to define delayed gallbladder emptying found no association between an abnormal GBEF and improved clinical response to cholecystectomy (7,8,14,18,(25)(26)(27). In contrast, Krishna et al reported that both GBEF <35% and pain reproduction during the test were associated with higher rates of symptom resolution (17).…”

Section: Cholescintigraphymentioning

confidence: 99%

“…Biliary dyskinesia is now among the most common conditions resulting in cholecystectomy in children and adolescents (11)(12)(13). However, long-term follow-up data suggests that certain patients undergoing surgical intervention for biliary dyskinesia will re-develop symptoms (14). It remains difficult for physicians to predict which patients will achieve long-term benefits from surgery.…”

Section: Introductionmentioning

confidence: 99%

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Biliary Dyskinesia in Children and Adolescents: A Mini Review

et al. 2020

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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 cutoff values. There are data suggesting that more extreme cutoff 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.

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