ImportanceBiliary dyskinesia is a disorder characterized by biliary pain, a sonographically normal gallbladder, and a reduced gallbladder ejection fraction on cholecystokinin-cholescintigraphy (CCK-HIDA) scan. Laparoscopic cholecystectomy remains a common treatment for biliary dyskinesia despite a lack of high-quality evidence supporting the practice. The following review summarizes the current biliary dyskinesia outcomes data, the diagnostic strategies and their limitations, biliary dyskinesia in the pediatric population, the emerging phenomenon of the hyperkinetic gallbladder, and suggestions for addressing identified knowledge gaps.ObservationsThe majority of studies on the topic are retrospective, with wide variations in inclusion criteria and definition of biliary pain. Most report a very short follow-up interval, often a single office visit, with variable and nonstandardized definitions of a satisfactory outcome. Despite a published Society of Nuclear Medicine guideline for its performance, CCK-HIDA scan protocols vary among institutions, which has led to considerable variability in the consistency and reproducibility of CCK-HIDA results. The few prospective studies available, although small and heterogeneous, support a role for cholecystectomy in the treatment of adult biliary dyskinesia. Despite these knowledge gaps, biliary dyskinesia is now the number 1 indication for cholecystectomy in children. Cholecystectomy for the hyperkinetic gallbladder appears to be an emerging phenomenon, despite, as in biliary dyskinesia, a lack of quality data supporting this practice. Randomized trials addressing these gaps are needed but have been difficult to conduct owing to strong clinician and patient bias toward surgery and the lack of a criterion-standard nonsurgical treatment for the control arm.Conclusions and RelevanceThe use of cholecystectomy for adult biliary dyskinesia is reasonable based on the available data. Insufficient data exist regarding laparoscopic cholecystectomy for pediatric dyskinesia and the hyperkinetic gallbladder population. Large-scale prospective studies, either randomized trials or large prospectively followed cohort studies, are needed to address the knowledge gaps surrounding this controversial diagnosis.

中文翻译：

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胆道运动障碍——争议、诊断和治疗


重要性胆道运动障碍是一种以胆道疼痛、超声检查胆囊正常以及缩胆素胆囊闪烁显像 (CCK-HIDA) 扫描胆囊射血分数降低为特征的疾病。尽管缺乏高质量证据支持，腹腔镜胆囊切除术仍然是胆道运动障碍的常见治疗方法。以下综述总结了当前胆道运动障碍的结果数据、诊断策略及其局限性、儿科人群中的胆道运动障碍、新出现的胆囊运动亢进现象以及解决已发现的知识差距的建议。 观察 大多数有关该主题的研究都是回顾性的，胆道疼痛的纳入标准和定义存在很大差异。大多数报告的随访间隔很短，通常是单次就诊，对满意结果的定义各不相同且非标准化。尽管核医学协会已发布其性能指南，但 CCK-HIDA 扫描方案因机构而异，这导致 CCK-HIDA 结果的一致性和可重复性存在相当大的差异。现有的少数前瞻性研究虽然规模较小且异质性强，但都支持胆囊切除术在治疗成人胆道运动障碍中的作用。尽管存在这些知识差距，胆道运动障碍现在是儿童胆囊切除术的第一大适应症。胆囊切除术治疗胆囊运动亢进似乎是一种新兴现象，尽管与胆道运动障碍一样，缺乏支持这种做法的高质量数据。 需要进行随机试验来解决这些差距，但由于临床医生和患者对手术的强烈偏见以及对照组缺乏标准的非手术治疗，因此很难进行。结论和相关性使用胆囊切除术治疗成人胆道运动障碍是合理的就现有数据而言。关于腹腔镜胆囊切除术治疗儿童运动障碍和胆囊运动过度人群的数据不足。需要进行大规模前瞻性研究，无论是随机试验还是大型前瞻性队列研究，以解决围绕这一有争议的诊断的知识差距。