Biliary Dyskinesia in Children: A Systematic Review

Area of Science:

• Pediatric Gastroenterology
• Surgical Outcomes Research

Background:

• Pediatric cholecystectomy rates for biliary dyskinesia are increasing in the US, unlike other nations.
• Biliary dyskinesia is a recognized functional gallbladder disorder in adults, distinct from pediatric diagnostic criteria often including upper abdominal pain and abnormal gallbladder ejection fraction (GBEF).

Purpose of the Study:

• To systematically review the literature on pediatric biliary dyskinesia.
• To evaluate the validity and reliability of diagnostic criteria and GBEF.
• To assess outcomes following cholecystectomy for this condition in children.

Main Methods:

• A systematic review adhering to PRISMA guidelines was conducted.
• Searched seven major databases and screened bibliographies for relevant studies.
• Included 31 retrospective chart reviews, noting heterogeneity in diagnostic criteria and GBEF values.

Main Results:

• Significant heterogeneity exists in diagnostic criteria and GBEF thresholds for pediatric biliary dyskinesia.
• Outcomes after laparoscopic cholecystectomy demonstrated a wide success range (34%-100%), with no consensus on influencing factors.
• Retrospective study designs limit the interpretation of diagnostic and treatment safety and efficacy.

Conclusions:

• There is a lack of consensus on defining symptoms, validating diagnostic tests, and comparing medical versus surgical management for pediatric biliary dyskinesia.
• Overlapping symptoms with functional dyspepsia complicate diagnosis.
• Further research, including randomized controlled trials, is needed to establish clear diagnostic and treatment guidelines.