The rising tide of cholecystectomy for biliary dyskinesia

A study in the latest issue of the Alimentary Pharmacology & Therapeutics determined trends in cholecystectomy rates for biliary dyskinesia in the United States.

Expert consensus defines biliary dyskinesia as a rare disorder of the gall-bladder characterised by pain and impaired gall-bladder function.
 
Dr Bielefeldt and colleagues from Pennsylvania, USA determined trends in cholecystectomy rates for biliary dyskinesia in the United States.
 
As biliary dyskinesia does not have a distinct diagnosis code, the narrative diagnoses for patients were reviewed and abstracted for 200 patients treated for the most commonly used diagnosis codes for biliary dyskinesia (validation sample).

Time trends in cholecystectomies and hospitalisations for biliary diseases were assessed using the Nationwide Inpatient Sample (Agency for Healthcare Research and Quality) based on codes for cholecystectomy and diagnosis codes for different biliary disorders.
 
The team found that in the validation sample, biliary dyskinesia accounted for 81% of the patients with gall-bladder disease not elsewhere specified.

Biliary dyskinesia accounted for 81% of patients with gall-bladder disease

Alimentary Pharmacology & Therapeutics

Between 1997 and 2010, admissions for acute cholecystitis and complications of gallstone disease decreased slightly, whereas admissions with the primary diagnosis tripled.

The team observed that this rise was most pronounced in the pediatric population, with biliary dyskinesia accounting for more than 10% of cholecystectomies.

Compared with acute biliary diseases, the research team found that significantly more of the elective hospitalisations were covered by private insurances.
 
Dr Bielefeldt's team concluded, "Practice patterns differ from expert opinion, with biliary dyskinesia accounting for an increasing fraction of cholecystectomies."

"The rise in these elective interventions is associated with a shift to a younger, low risk and predominantly privately insured population. Considering the benign nature of biliary dyskinesia, it is time to reassess the need for operative interventions, which have never been compared with active conservative therapy."