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Biliary dyskinesia: is the problem with Oddi?

J Wood1, A J A Holland, A Shun

  • 1Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, The University of Sydney, Locked Bag 4001, NSW 2145, Westmead, Australia.

Pediatric Surgery International
|February 11, 2004
PubMed

Insights

Cholecystectomy for biliary dyskinesia in children, defined by low gallbladder ejection fraction (GBEF), showed mixed results. This condition is uncommon, and surgery is not always effective for persistent abdominal pain.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Biliary System Physiology

Background:

  • Recurrent upper abdominal pain in children can be challenging to diagnose.
  • Gallbladder ejection fraction (GBEF) testing is used to evaluate for biliary dyskinesia.
  • Cholelithiasis (gallstones) is typically absent in biliary dyskinesia.

Purpose of the Study:

  • To evaluate the effectiveness of cholecystectomy for children with biliary dyskinesia.
  • To assess the role of cholecystokinin (CCK)-provoked GBEF in diagnosing biliary dyskinesia.
  • To explore alternative diagnostic methods for children with unexplained abdominal pain.

Main Methods:

  • Retrospective review of five children undergoing cholecystectomy for presumed biliary dyskinesia.
  • Evaluation included normal biliary ultrasound, decreased CCK-provoked GBEF (<50%), and absence of other GI pathology.
  • Pathological examination of gallbladder tissue and operative cholangiography were performed.

Main Results:

  • All five patients had normal ultrasounds and pathologically confirmed chronic inflammation.
  • Two out of five patients experienced complete symptom resolution post-cholecystectomy.
  • Three patients had persistent abdominal pain, indicating limited surgical efficacy.

Conclusions:

  • Biliary dyskinesia is an uncommon cause of persistent pediatric abdominal pain.
  • Cholecystectomy is not consistently effective in alleviating symptoms associated with biliary dyskinesia.
  • Reliance solely on CCK-provoked GBEF for surgical indication is questionable; sphincter of Oddi manometry may offer better assessment.

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