Functional gallbladder disorder: Interim analysis of a prospective cohort study

BACKGROUND

Functional gallbladder disorder (FGBD) remains a controversial indication for cholecystectomy.

METHODS

A prospective cohort study enrolled patients strictly meeting Rome criteria for FGBD, and cholecystectomy was performed. They were assessed pre- and 3 and 6 months postoperatively with surveys of abdominal pain and quality of life (RAPID and SF-12 surveys, respectively). Interim analysis was performed.

RESULTS

Although neither ejection fraction nor pain reproduction predicted success after cholecystectomy, the vast majority of enrolled patients had a successful outcome after undergoing cholecystectomy for FGBD: of a planned 100 patients, 46 were enrolled. Of 31 evaluable patients, 26 (83.9 ​%) reported RAPID improvement and 28 (93.3 ​%) SF12 improvement at 3- or 6-month follow-up.

CONCLUSION

FGBD, strictly diagnosed, should perhaps no longer be a controversial indication for cholecystectomy, since its success rate for biliary pain in this study was similar to that for symptomatic cholelithiasis. Larger-scale studies or randomized trials may confirm these findings.

Variability in perioperative evaluation and resource utilization in pediatric patients with suspected biliary dyskinesia: A multi-institutional retrospective cohort study

INTRODUCTION

Biliary dyskinesia (BD) is a common indication for pediatric cholecystectomy. While diagnosis is primarily based on diminished gallbladder ejection fraction (GB-EF), work-up and management in pediatrics is controversial.

METHODS

We conducted a multi-institutional retrospective review of children undergoing cholecystectomy for BD to compare perioperative work-up and outcomes.

RESULTS

Six hundred seventy-eight patients across 16 institutions were included. There was no significant difference in gender, age, or BMI between institutions. Most patients were white (86.3%), non-Hispanic (79.9%), and had private insurance (55.2%). Gallbladder ejection fraction (EF) was reported in 84.5% of patients, and 44.8% had an EF <15%. 30.7% of patients were initially seen by pediatric surgeons, 31.3% by pediatric gastroenterologists, and 23.4% by the emergency department with significant variability between institutions (p < 0.001). Symptoms persisted in 35.3% of patients post-operatively with a median follow-up of 21 days (IQR 13, 34). On multivariate analysis, only non-white race and the presence of psychiatric comorbidities were associated with increased risk of post-operative symptoms.

CONCLUSION

There is significant variability in evaluation and follow-up both before and after cholecystectomy for BD. Prospective research with standardized data collection and follow-up is needed to develop and validate optimal care pathways for pediatric patients with suspected BD.

STUDY TYPE

Case Series, Retrospective Review.

LEVEL OF EVIDENCE

Level IV.

Is functional gallbladder disease truly increasing? Results from the Rochester Epidemiology Project

INTRODUCTION

Reports from US administrative databases showed an increase in cholecystectomy rate for functional gallbladder disorder (FGBD), a disease is not well recognized elsewhere. We aimed to identify the incidence and cholecystectomy rate for FGBD in an epidemiologically well-defined and prospectively studied population and compare results to published data.

METHODS

After IRB approval, we extracted data from the NIH funded Rochester Epidemiology Project. We used ICD-9 codes (575.8) and (575.9) to identify patients with FGBD from 2000 to 2014.

RESULTS

Between 2000 and 2014 we identified 253 patients with specified ICD-9 codes and no stones among a population of 135,000. Based on their medical records, 24 patients had confirmed FGBD, the incidence was 1.77/10,000 and cholecystectomy rate was for these patients was 70%.

CONCLUSION

The incidence of FGBD was much lower than State data with similar cholecystectomy rate. Additional investigation may be needed to understand if cholecystectomy rate is truly increasing.

Decision-making patterns in managing children with suspected biliary dyskinesia

AIM

To explore and to analyze the patterns in decision-making by pediatric gastroenterologists in managing a child with a suspected diagnosis of functional gallbladder disorder (FGBD).

METHODS

The questionnaire survey included a case history with right upper quadrant pain and was sent to pediatric gastroenterologists worldwide via an internet list server called the PEDGI Bulletin Board.

RESULTS

Differences in decision-making among respondents in managing this case were observed at each level of investigations and management. Cholecystokinin-scintigraphy scan (CCK-CS) was the most common investigation followed by an endoscopy. A proton pump inhibitor was most commonly prescribed treating the condition. The majority of respondents considered a referral for a surgical evaluation when CCK-CS showed a decreased gallbladder ejection fraction (GBEF) value with biliary-type pain during CCK injection.

CONCLUSION

CCK infusion rate in CCK-CS-CS and GBEF cut-off limits were inconsistent throughout practices. The criteria for a referral to a surgeon were not uniform from one practitioner to another. A multidisciplinary team approach with pediatric gastroenterologists and surgeons is required guide the decision-making managing a child with suspected FGBD. ​