Prediction of symptom improvement in children with biliary dyskinesia

Mahida, Justin B.; Sulkowski, Jason P.; Cooper, Jennifer N.; King, Austin P.; Deans, Katherine J.; King, Denis R.; Minneci, Peter C.

doi:10.1016/j.jss.2015.03.056

Cited by 22 publications

(36 citation statements)

References 28 publications

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“…However, there was no observed correlation between with GBEF and the presence of gallbladder pathology such as cholecystitis, cholelithiasis, or cholesterolosis[28]. Interestingly Mahida et al[29] reported symptom improvement by 82% of 153 children with FGBD undergoing cholecystectomy regardless of their GBEF values. The number of children undergoing cholecystectomy has increased in the past decade[30].…”

Section: Discussionmentioning

confidence: 99%

Decision-making patterns in managing children with suspected biliary dyskinesia

Nakayuenyongsuk

Choudry

Yeung

et al. 2017

WJCP

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AIMTo explore and to analyze the patterns in decision-making by pediatric gastroenterologists in managing a child with a suspected diagnosis of functional gallbladder disorder (FGBD).METHODSThe questionnaire survey included a case history with right upper quadrant pain and was sent to pediatric gastroenterologists worldwide via an internet list server called the PEDGI Bulletin Board.RESULTSDifferences in decision-making among respondents in managing this case were observed at each level of investigations and management. Cholecystokinin-scintigraphy scan (CCK-CS) was the most common investigation followed by an endoscopy. A proton pump inhibitor was most commonly prescribed treating the condition. The majority of respondents considered a referral for a surgical evaluation when CCK-CS showed a decreased gallbladder ejection fraction (GBEF) value with biliary-type pain during CCK injection.CONCLUSIONCCK infusion rate in CCK-CS-CS and GBEF cut-off limits were inconsistent throughout practices. The criteria for a referral to a surgeon were not uniform from one practitioner to another. A multidisciplinary team approach with pediatric gastroenterologists and surgeons is required guide the decision-making managing a child with suspected FGBD.

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Section: Discussionmentioning

confidence: 99%

Decision-making patterns in managing children with suspected biliary dyskinesia

Nakayuenyongsuk

Choudry

Yeung

et al. 2017

WJCP

View full text Add to dashboard Cite

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“…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). Mahida et al reported a positive predictive value of ∼80% for GBEF in identifying patients with a good clinical outcome, although the clinical cutoff was not provided (28). There are conflicting results on whether clinical response is better predicted by even lower GBEFs.…”

Section: Cholescintigraphymentioning

confidence: 99%

“…A partial clinical response is reported in 74-85% (2 studies) and complete symptom resolution in 44-60.7% (3 studies) (6,25,28,30). In all but one of these studies, only 26-53% of patients were available for long term follow-up assessment (6,25,28,30). The other study had 81% of patients available for assessment but defined long term as only >4 weeks post-operative (17).…”

Section: Cholecystectomy Outcomementioning

confidence: 99%

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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“…29 In older children and adolescents, hepatobiliary scintigraphy is used for diagnosis of acute cholecystitis 17 or chronic cholecystitis or biliary dyskinesia. 30,31 Hepatobiliary scintigraphy may also be used for evaluation of biliary leaks in the postoperative or post-traumatic setting. [32][33][34] Genitourinary Applications Dynamic renal scintigraphy and diuresis renography Dynamic renal scintigraphy is used to assess renal perfusion, tubular function, and collecting system drainage in renal transplantation, either routinely within 24 to 72 hours of transplantation (Fig.…”

Section: Hepatobiliary Applicationsmentioning

confidence: 99%