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Decision-making patterns in managing children with suspected biliary dyskinesia

Warapan Nakayuenyongsuk1, Hassan Choudry1, Karla Au Yeung1

  • 1Warapan Nakayuenyongsuk, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA 94305, United States.

World Journal of Clinical Pediatrics
|May 26, 2017
PubMed

Insights

Pediatric gastroenterologists show varied approaches to diagnosing functional gallbladder disorder (FGBD). A multidisciplinary team is needed for consistent management and surgical referrals in children with suspected FGBD.

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.
Abstract

Keywords:
Biliary dyskinesiaCholecystectomyFunctional gallbladder disorderGallbladder ejection fraction

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