Decision-making patterns in managing children with suspected biliary dyskinesia

Area of Science:

• Pediatric Gastroenterology
• Hepatobiliary Disorders
• Diagnostic Decision-Making

Background:

• Functional gallbladder disorder (FGBD) presents diagnostic challenges in pediatric patients.
• Variability exists in current clinical practices for managing suspected FGBD.

Purpose of the Study:

• To analyze decision-making patterns among pediatric gastroenterologists for FGBD.
• To identify inconsistencies in diagnostic and management strategies for pediatric FGBD.

Main Methods:

• A global online questionnaire survey was distributed to pediatric gastroenterologists.
• The survey included a case vignette of a child with right upper quadrant pain suggestive of FGBD.

Main Results:

• Significant variations were noted in investigations and management protocols for pediatric FGBD.
• Cholecystokinin-scintigraphy scan (CCK-CS) and endoscopy were common investigations; proton pump inhibitors were frequently prescribed.
• Referral for surgery was common when CCK-CS indicated reduced gallbladder ejection fraction (GBEF) with biliary pain.

Conclusions:

• Inconsistent CCK-CS parameters (infusion rate, GBEF cut-offs) and referral criteria for pediatric FGBD were observed.
• A standardized, multidisciplinary approach involving pediatric gastroenterologists and surgeons is essential for optimal FGBD management in children.