Predictors for Benefit After Cholecystectomy for Biliary Dyskinesia in a Child

 

Patient selection: pediatric patient with biliary dyskinesia

 

Positive outcome to surgery - one or both of the following:

(1) complete resolution of symptoms

(2) complete satisfaction with medical care (based on a 10 point Likert scale)

 

Factors predicting benefit from cholecystectomy:

(1) presence of abdominal pain

(2) presence of nausea

(3) gallbladder emptying < 15% after administration of cholecystokinin (using 99m technetium choletec hepatobiliary nuclear scan)

 

percent emptying =

= ((reading before cholecystokinin) - (reading after cholecystokinin)) / (reading before cholecystokinin) * 100%

 

The presence of all 3 factors indicates a child with a high probability of benefiting from cholecystectomy. The odds ratios for benefit in univariate analysis (Table 1) were 8 for percent emptying, 5 for nausea and 1.7 for pain.

 

The absence of all 3 factors suggests a low probability of benefit from surgery.