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
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.
Publication Title
Journal of pediatric surgery
Volume
59
Issue
11
First Page
161678
Last Page
161678
Recommended Citation
Kulaylat, A., Lucas, D., Chang, H., Derderian, S., Beres, A., Ham, P., Huerta, C., Sulkowski, J., Wakeman, D., Englum, B., Gulack, B., Acker, S., Gonzalez, K., Levene, T., Christison-Lagay, E., Mansfield, S., Yousef, Y., Pennell, C., Russell, K., Rentea, R., Tashiro, J., Diesen, D., Alemayehu, H., Ricca, R., Kelley-Quon, L., & Rialon, K. (2024). Evaluation and Management of Biliary Dyskinesia in Children and Adolescents: A Systematic Review From the APSA Outcomes and Evidence-Based Committee.. Journal of pediatric surgery, 59 (11), 161678-161678. https://doi.org/https://doi.org/10.1016/j.jpedsurg.2024.08.018