Biliary Dyskinesia Management Differs for Adult and Pediatric Patients

Richmond BK. Biliary Dyskinesia—Controversies, Diagnosis, and Management: A Review. JAMA Surg. 2024;159(9):1079-1084.

This article provided a clearly written review of the literature focusing on the diagnosis and management of biliary dyskinesia, a disorder characterized by biliary pain, a normal gallbladder on ultrasound imaging, and reduced gallbladder ejection fraction on cholecystokinin-cholescintigraphy (CCK-HIDA). Recommendations for documentation of biliary pain using the Rome-IV criteria as well as clinical practice guidelines for determination of gallbladder ejection fraction are presented in the article.

Laparoscopic cholecystectomy is the first-line treatment recommended for patients with biliary dyskinesia; however, data cited in the review confirmed that high-quality evidence supporting this treatment approach is not available. This finding is important given the fact that biliary dyskinesia is the most common indication for cholecystectomy in children.

Additional evidence reviewed in the article showed that there is high variability in results of CCK-HIDA. Hyperkinetic gallbladder diagnosed based on CCK-HIDA studies is increasing as an indication for laparoscopic cholecystectomy.

Based on the available evidence, laparoscopic cholecystectomy is indicated for treatment of biliary dyskinesia in adults, but data supporting use of this procedure for biliary dyskinesia in children and in patients with hyperkinetic gallbladder are insufficient to justify a recommendation for surgery as the standard treatment in these groups. Alternative treatments such as amitriptyline may be considered for these patient groups although supporting data are weak.