Evaluation and Management of Biliary Dyskinesia in Children and Adolescents: A Systematic Review From the APSA Outcomes and Evidence-Based Committee.
Document Type
Article
Publication Date
11-2024
Identifier
DOI: 10.1016/j.jpedsurg.2024.08.018
Abstract
INTRODUCTION: The diagnosis and management of biliary dyskinesia in children and adolescents remains variable and controversial. The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee (APSA OEBP) performed a systematic review of the literature to develop evidence-based recommendations.
METHODS: Through an iterative process, the membership of the APSA OEBP developed five a priori questions focused on diagnostic criteria, indications for cholecystectomy, short and long-term outcomes, predictors of success/benefit, and outcomes of medical management. A systematic review was conducted, and articles were selected for review following Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Risk of bias was assessed using Methodologic Index for Non-Randomized Studies (MINORS) criteria. The Oxford Levels of Evidence and Grades of Recommendation were utilized.
RESULTS: The diagnostic criteria for biliary dyskinesia in children and adolescents are not clearly defined. Cholecystectomy may provide long-term partial or complete relief in some patients; however, there are no reliable predictors of symptom relief. Some patients may experience resolution of symptoms with non-operative management.
CONCLUSIONS: Pediatric biliary dyskinesia remains an ill-defined clinical entity. Pediatric-specific guidelines are necessary to better characterize the condition, guide work-up, and provide management recommendations. Prospective studies are necessary to more reliably identify patients who may benefit from cholecystectomy.
LEVEL OF EVIDENCE: Level 3-4.
TYPE OF STUDY: Systematic Review of Level 3-4 Studies.
Journal Title
Journal of pediatric surgery
Volume
59
Issue
11
First Page
161678
Last Page
161678
MeSH Keywords
Humans; Biliary Dyskinesia; Adolescent; Child; Cholecystectomy; Evidence-Based Medicine; Treatment Outcome
Keywords
Acalculou; Biliary colic; Biliary dyskinesia; Gallbladder disease; Gallbladder dysfunction; Hyperkinesia; Hypokinesia; Outcomes
Recommended Citation
Kulaylat AN, Lucas DJ, Chang HL, et al. Evaluation and Management of Biliary Dyskinesia in Children and Adolescents: A Systematic Review From the APSA Outcomes and Evidence-Based Committee. J Pediatr Surg. 2024;59(11):161678. doi:10.1016/j.jpedsurg.2024.08.018
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