Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. May 8, 2017; 6(2): 124-131
Published online May 8, 2017. doi: 10.5409/wjcp.v6.i2.124
Decision-making patterns in managing children with suspected biliary dyskinesia
Warapan Nakayuenyongsuk, Hassan Choudry, Karla Au Yeung, Wikrom Karnsakul
Warapan Nakayuenyongsuk, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA 94305, United States
Hassan Choudry, Karla Au Yeung, Wikrom Karnsakul, Pediatric Liver Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Institutional review board statement: The study was reviewed and approved by Institutional review board statement of Johns Hopkins University School of Medicine.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wikrom Karnsakul, MD, Associate Professor, Pediatric Liver Center, Johns Hopkins University School of Medicine, CMSC-2 600 North Wolfe Street, Baltimore, MD 21287, United States. wkarnsa1@jhmi.edu
Telephone: +1-410-9558769 Fax: +1-410-9551464
Received: September 19, 2016
Peer-review started: September 20, 2016
First decision: October 28, 2016
Revised: December 4, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: May 8, 2017
Processing time: 231 Days and 14.9 Hours
Abstract
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. ​

Keywords: Biliary dyskinesia; Functional gallbladder disorder; Cholecystectomy; Gallbladder ejection fraction

Core tip: Functional gallbladder disorder (FGBD) is a common motility disorder of the gallbladder that results in abdominal pain and cholecystectomy in children. The guideline for managing children with FGBD is lacking. The questionnaire survey is a pilot study performed by pediatric gastroenterologists worldwide via the PEDGI Bulletin Board. Differences in decision-making among respondents in managing this case were observed at each level of investigations and management. Since, a different risk-benefit ratio should be considered in children with suspected FGBD. The authors include an algorithm for the approach in managing children with suspected FGBD based on literature review.