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Evaluation and Management of Biliary Dyskinesia in Children and Adolescents: A Systematic Review From the APSA

Afif N Kulaylat1, Donald J Lucas2, Henry L Chang3

  • 1Penn State Children's Hospital, Division of Pediatric Surgery, Hershey, PA, USA.

Journal of Pediatric Surgery
|September 3, 2024
PubMed

Insights

Pediatric biliary dyskinesia lacks clear diagnostic criteria, with variable outcomes for cholecystectomy and non-operative management. Further research is needed for better patient selection and treatment guidelines.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Evidence-Based Medicine

Background:

  • Biliary dyskinesia diagnosis and management in pediatric patients is inconsistent and debated.
  • The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee (APSA OEBP) conducted a systematic review to establish evidence-based recommendations.

Purpose of the Study:

  • To systematically review the literature on pediatric biliary dyskinesia.
  • To develop evidence-based recommendations for diagnosis and management.

Main Methods:

  • Systematic review of Level 3-4 studies following PRISMA guidelines.
  • Development of five key questions regarding diagnostic criteria, cholecystectomy indications, outcomes, predictors of success, and medical management.
  • Assessment of risk of bias using MINORS criteria and utilization of Oxford Levels of Evidence.

Main Results:

  • Diagnostic criteria for pediatric biliary dyskinesia are not well-defined.
  • Cholecystectomy may offer partial or complete symptom relief, but reliable predictors of success are lacking.
  • Some patients experience symptom resolution with non-operative management.

Conclusions:

  • Pediatric biliary dyskinesia is an ill-defined condition requiring pediatric-specific guidelines.
  • Further prospective studies are essential to identify patients who would benefit from cholecystectomy.
  • Improved characterization and work-up guidance are needed for this condition.
Abstract

Keywords:
AcalculouBiliary colicBiliary dyskinesiaGallbladder diseaseGallbladder dysfunctionHyperkinesiaHypokinesiaOutcomes

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