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Endoscopic retrograde cholangiography for pediatric choledocholithiasis: Assessing the need for endoscopic
Douglas S Fishman1, Bruno P Chumpitazi1, Isaac Raijman1
1Douglas S Fishman, Bruno P Chumpitazi, Cynthia Man-Wai Tsai, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, United States.
Insights
Adult guidelines for common bile duct stones (CBDS) identify most pediatric cases. A modified score using conjugated bilirubin shows improved sensitivity for detecting pediatric CBDS, potentially reducing unnecessary procedures.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Diagnostic Imaging
Background:
- Choledocholithiasis (common bile duct stones) diagnosis in children often relies on adult guidelines.
- Accurate identification of pediatric choledocholithiasis is crucial to prevent complications and guide treatment.
Purpose of the Study:
- To evaluate the effectiveness of current adult guidelines in identifying pediatric patients with choledocholithiasis.
- To identify predictive factors for common bile duct stones (CBDS) in pediatric patients.
Main Methods:
- Retrospective analysis of 44 pediatric patients undergoing ERCP for suspected choledocholithiasis.
- Stratification of patients based on American Society of Gastrointestinal Endoscopy (ASGE) guidelines for suspected CBDS.
- Evaluation of risk factors including conjugated bilirubin, ALT, and GGT levels.
Main Results:
- Common bile duct stones (CBDS) were confirmed in 84% of patients during ERCP.
- Elevated conjugated bilirubin (≥ 0.5 mg/dL) was an independent risk factor for CBDS.
- A modified scoring system incorporating conjugated bilirubin demonstrated higher sensitivity (81.2%) for CBDS detection compared to standard ASGE criteria (59.5%).
Conclusions:
- Current adult guidelines are largely effective in identifying pediatric choledocholithiasis.
- A modified scoring system, particularly using conjugated bilirubin, may enhance diagnostic accuracy in children.
- Development of pediatric-specific guidelines could further optimize detection and reduce invasive procedures.
Aim:
To assess pediatric patients for choledocholithiasis. We applied current adult guidelines to identify predictive factors in children.
Methods:
A single-center retrospective analysis was performed at a tertiary children's hospital. We evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography (ERCP) for suspected choledocholithiasis. Patients were stratified into those with common bile duct stones (CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy (ASGE) guidelines (Very Strong and Strong criteria) for suspected CBDS.
Results:
CBDS were identified in 84% at the time of ERCP. Abdominal ultrasound identified CBDS in 36% of patients. Conjugated bilirubin ≥ 0.5 mg/dL was an independent risk factor for CBDS (P = 0.003). The Very Strong (59.5%) and Strong (48.6%) ASGE criteria identified the majority of patients (P = 0.0001). A modified score using conjugated bilirubin had a higher sensitivity (81.2% vs 59.5%) and more likely to identify a stone than the standard criteria, odds ratio of 25.7 compared to 8.8. Alanine aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25, respectively.
Conclusion:
Current adult guidelines identified the majority of pediatric patients with CBDS, but specific pediatric guidelines may improve detection, thus decreasing risks and unnecessary procedures.
