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Gallbladder Ejection Fraction Is Unrelated to Gallbladder Pathology in Children and Adolescents
Patrick M Jones1, Marc B Rosenman, Marian D Pfefferkorn
1*Bronson Pediatric Gastroenterology, Bronson Children's Hospital, Kalamazoo, Michigan†Section of Children's Health Services Research‡Section of Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics§Section of Pediatric Surgery, Department of Surgery||Regenstrief Institute, Indiana University School of Medicine, Indianapolis.
Insights
Gallbladder ejection fraction (GBEF) from HIDA scans does not predict gallbladder pathology in children. This finding suggests caution when interpreting HIDA scan results for pediatric patients with biliary dyskinesia.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Hepatobiliary System
Background:
- Biliary dyskinesia is often diagnosed using gallbladder ejection fraction (GBEF) <35% in adults, leading to cholecystectomy.
- This disorder is poorly characterized in pediatric populations.
- Hepatic iminodiacetic acid (HIDA) scans are used to assess gallbladder function.
Purpose of the Study:
- To investigate the relationship between GBEF and gallbladder pathology in patients aged 21 years and younger.
- To determine if GBEF is a reliable predictor of gallbladder disease in children and adolescents.
Main Methods:
- Retrospective analysis of HIDA scan and gallbladder pathology reports from a statewide medical record repository (2004-2013).
- Data mining techniques were used to extract GBEF results.
- Mixed effects logistic regression was employed to analyze the correlation between GBEF, patient demographics, and gallbladder pathology (cholecystitis, cholelithiasis, cholesterolosis).
Main Results:
- A total of 2,841 HIDA scans from 2,558 patients were analyzed.
- 310 patients had both HIDA scan and gallbladder pathology reports.
- GBEF did not correlate with the presence of gallbladder pathology after controlling for demographic factors and pathologist.
Conclusions:
- Hypokinetic gallbladders (low GBEF) are not more likely to have associated gallbladder pathology in pediatric patients.
- Clinical interpretation of HIDA scan results in children and adolescents requires careful consideration.
- The study highlights a potential disconnect between HIDA scan findings and histopathological evidence of disease in younger populations.
Objectives:
Biliary dyskinesia is a common diagnosis that frequently results in cholecystectomy. In adults, most clinicians use a cut off value for the gallbladder ejection fraction (GBEF) of <35% to define the disease. This disorder is not well characterized in children. Our aim was to determine the relation between GBEF and gallbladder pathology using a large statewide medical record repository.
Methods:
We obtained records from all patients of 21 years and younger who underwent hepatic iminodiacetic acid (HIDA) testing within the Indiana Network for Patient Care from 2004 to 2013. GBEF results were obtained from radiology reports using data mining techniques. Age, sex, race, and insurance status were obtained for each patient. Any gallbladder pathology obtained subsequent to an HIDA scan was also obtained and parsed for mention of cholecystitis, cholelithiasis, or cholesterolosis. We performed mixed effects logistic regression analysis to determine the influence of age, sex, race, insurance status, pathologist, and GBEF on the presence of these histologic findings.
Results:
Two thousand eight hundred forty-one HIDA scans on 2558 patients were found. Of these, 310 patients had a full-text gallbladder pathology report paired with the HIDA scan. GBEF did not correlate with the presence of gallbladder pathology (cholecystitis, cholelithiasis, or cholesterolosis) when controlling for age, sex, race, insurance status, and pathologist using a mixed effects model.
Conclusions:
Hypokinetic gallbladders are no more likely to have gallbladder pathology than normal or hyperkinetic gallbladders in the setting of a patient with both a HIDA scan and a cholecystectomy. Care should be used when interpreting the results of HIDA scans in children and adolescents.
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