Trends of Cholecystectomies for Presumed Biliary Dyskinesia in Children in the United States.

Background: Biliary dyskinesia is a controversial clinical entity. Standardized diagnostic test and management guidelines are lacking in children. Published data suggest that long-term outcomes of surgical and medical management are similar. We sought to determine national population-based trends of cholecystectomies performed in children for biliary dyskinesia and associated healthcare expenditure in the US over a 10-year period. Methods: Using Nationwide Inpatient Sample and the International Classification of Diseases, the 9th revision clinical modification codes, we identified children who had a cholecystectomy for biliary dyskinesia from 2002-2011 in the United States. Results: A total of 66,380 cholecystectomies were identified as primary procedural diagnosis using weighted analysis from 2002 to 2011 in children. Biliary dyskinesia was the primary indication for cholecystectomy in 6,674 (10.8%) of the patients. Over the study period, the number of cholecystectomies performed for biliary dyskinesia in children increased from 6.6% in 2002 to 10.6% in 2011, a majority were adolescent white Caucasian females. The annual health care expenditure for surgical management of biliary dyskinesia for children in the U.S. was estimated to almost $16 million/year. Conclusion: Despite lack of standardized diagnostic criteria and variable outcomes of surgical intervention reported in pediatric literature, cholecystectomies are commonly performed for children with biliary dyskinesia in the United States. Consensus guidelines for the diagnosis and management of this controversial disorder in children are needed. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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