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. 2021 Jul 25:6:36.
doi: 10.21037/tgh-20-258. eCollection 2021.

Biliary hyperkinesia in adolescents-it isn't all hype!

Maggie E Bosley  1 , Jillian Jacobson  2 , Michaela W G Gaffley  1 , Michael A Beckwith  3 , Samir R Pandya  4 , James S Davis  4 , Lucas P Neff  5
Affiliations

Biliary hyperkinesia in adolescents-it isn't all hype!

Maggie E Bosley et al. Transl Gastroenterol Hepatol. .

Abstract

Background: Biliary dyskinesia generally refers to a hypofunctioning gallbladder with an ejection fraction (EF) of <35% on hepatobiliary iminodiacetic acid scan with cholecystokinin stimulation (CCK-HIDA testing). In adults, biliary hyperkinesia has a defined association with biliary colic symptoms and can be relieved with surgical intervention. This clinical entity has not been well described in children or adolescents. In fact, only recently have we seen biliary hyperkinesia on HIDA at our centers. To that end, we reviewed our recent experience with adolescents who have presented and been treated for this unusual clinical entity.

Methods: With IRB approval, we retrospectively reviewed the records of all patients with abnormally high HIDA EFs (>80%) cared for by the pediatric surgery services at two tertiary care centers over the span of a three-year period. Age, sex, BMI, CCK-HIDA results, and preoperative testing and post-operative pathology were noted. Resolution of symptoms was determined by subjective patient self-reporting at postoperative visit.

Results: Eighteen patients met inclusion criteria. Average age 15.7 (range, 10-17 years), median BMI 27.3 (±8.2). Fifteen patients were female and 3 were male. Average CCK-HIDA EF was 91.6% (±5.2), 82.4% of the patients had evidence of chronic cholecystitis and/or cholesterolosis on pathology. Postoperatively, 82.4% of the patients available for follow up (n=17) reported complete or near complete resolution of symptoms.

Conclusions: Biliary hyperkinesia is an emerging clinical entity in children and adolescents and has a similar presentation to biliary hypokinesia. While the pathophysiologic mechanism of pain is not fully elucidated, laparoscopic cholecystectomy appears to provide a surgical cure for these patients and should be considered in the differential for the patient with an unremarkable workup and history suggestive of biliary colic.

Keywords: Biliary dyskinesia; gallbladder emptying; hyperkinesis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tgh-20-258). The series “Current Topics in Pediatric General Surgery” was commissioned by the editorial office without any funding or sponsorship. SRP served as the unpaid Guest Editor of the series. The authors have no other conflicts of interest to declare.

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