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Endoscopic sphincterotomy in the management of bile duct stones in children
Showkat Ali Zargar1, Gul Javid, Bashir Ahmad Khan
1Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
Insights
Endoscopic sphincterotomy (ES) safely and effectively treats bile duct stones (BDS) in children, even those with severe complications or prior gallbladder removal. This procedure offers a high success rate for pediatric BDS management.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Hepatobiliary Surgery
Background:
- Endoscopic sphincterotomy (ES) is a standard treatment for bile duct stones (BDS) in adults.
- Pediatric BDS management requires specific safety and efficacy assessments.
Purpose of the Study:
- To evaluate the safety and efficacy of ES for treating BDS in children.
- To assess ES outcomes in critically ill pediatric patients with BDS complications.
Main Methods:
- ES was performed on 16 children (aged 7-16) with BDS over 33 months.
- Patients included those with and without gallbladders, and with coexisting conditions like roundworms.
- Seven patients presented with severe complications: cholangitis or pancreatitis.
Main Results:
- Technical success was achieved in 100% of patients.
- Complete stone extraction occurred in 93.8% of cases.
- Minor bleeding was the only complication, with no mortality.
Conclusions:
- ES is a safe and effective treatment for pediatric BDS.
- The procedure is suitable for children with prior cholecystectomy and severe complications.
- ES demonstrated efficacy regardless of gallbladder status in this pediatric cohort.
Objective:
Endoscopic sphincterotomy (ES) is a widely accepted method of extracting bile duct stones (BDS) in young as well as in elderly patients. The present study was undertaken to assess the safety and efficacy of ES for the treatment of BDS in children, seven of whom were critically sick because of suppurative cholangitis or pancreatitis.
Method:
Over a period of 33 months, ES was performed in 16 consecutive children aged 7-16 yr with BDS. Nine patients had gallbladder in situ, and seven had previously undergone cholecystectomy. The coexisting abnormalities were gallstones and hepatic duct stones in one patient each and dead fragmented roundworms in 11 patients. Seven (five with an intact gallbladder and two cholecystectomized) patients presented with severe complications of BDS such as severe cholangitis in six and acute severe pancreatitis in one.
Results:
ES was technically successful in all patients, and complete stone extraction was achieved in 15 (93.8%) patients. Complications were minor bleeding in one (6.3%) patient without mortality. One patient with coexisting gallstones underwent cholecystectomy at a later date. During a mean follow-up period of 4-32 months, one patient developed recurrent biliary symptoms because of biliary ascariasis.
Conclusions:
We conclude ES is a safe and an effective method of treating BDS in children with previous cholecystectomy, and in those presenting with severe complications of BDS, such as pyogenic cholangitis or acute pancreatitis regardless of the presence of gallbladder.
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