Related Experiment Video
Updated: Sep 15, 2025
A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
Published on: September 13, 2022
Influence of Stone Size on Spontaneous Migration of Choledocholithiasis in Pediatric Patients
Mauricio Andres Carreño Sanchez1, Mauro Ariel Capparelli1, Victor Hugo Ayarzabal1
1Division of General Surgery, J.P. Garrahan Hospital, Buenos Aires, Argentina.
Insights
Pediatric choledocholithiasis (bile duct stones) often resolve spontaneously. This study found that common bile duct stones smaller than 6 mm are significantly more likely to migrate on their own in children, potentially avoiding invasive procedures.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
- Diagnostic Imaging
Background:
- Choledocholithiasis (bile duct stones) occurs in 30% of pediatric gallstone cases.
- Spontaneous migration of common bile duct (CBD) stones is frequent in children.
- No prior pediatric studies have linked CBD stone size to spontaneous migration.
Purpose of the Study:
- To investigate the relationship between CBD stone size and characteristics and spontaneous migration in pediatric choledocholithiasis.
- To identify predictors of spontaneous stone clearance from the CBD in children.
Main Methods:
- Retrospective analysis of 75 pediatric patients with choledocholithiasis diagnosed via ultrasound.
- Evaluation of demographic, laboratory, and imaging data, including stone size and CBD diameter.
- Spontaneous migration defined by absence of CBD stones on follow-up imaging (MRCP, ERCP, or intraoperative cholangiography).
Main Results:
- The spontaneous migration rate was 57.3% in the study cohort.
- Multivariate analysis revealed pancreatitis and stone size as significant predictors of spontaneous migration.
- Receiver Operating Characteristic (ROC) curve analysis indicated that CBD stones <6 mm were strongly associated with spontaneous migration (p=0.001).
Conclusions:
- Common bile duct stone size <6 mm may predict spontaneous migration in pediatric choledocholithiasis.
- This finding can aid in clinical decision-making, potentially reducing unnecessary invasive procedures.
- Further research could refine criteria for expectant management in pediatric CBD stones.
Introduction:
The incidence of choledocholithiasis in pediatric patients with gallstones is higher than in adults (30 %). However, spontaneous migration is very common in these patients. To date, no pediatric studies have analyzed the relationship between stone size in the common bile duct (CBD) and spontaneous migration.
Objective:
To analyze the influence of stone size and characteristics in the CBD on the spontaneous migration of choledocholithiasis in pediatric patients.
Materials And Methods:
We conducted a retrospective study of patients diagnosed with choledocholithiasis by ultrasound at the "Prof. Dr. Juan P. Garrahan" Hospital from January 2010 to December 2023. Demographic data (age, sex), laboratory findings [amylase/lipase, total and direct bilirubin (TB and DB), alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase], and imaging findings (stone size, single or multiple stones, CBD diameter) were analyzed. Spontaneous migration was defined as the absence of CBD stones on confirmatory modalities: magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and/or intraoperative cholangiography.
Results:
A total of 110 patients with choledocholithiasis by ultrasound were reviewed. Patients with incomplete data on stone size (n = 35) were excluded, leaving 75 patients for final analysis. The mean age was 13 years (SD 2.3 years), and 74.6 % (n = 56) were female. Pancreatitis was associated in 30.6 % (n = 23) of cases. The spontaneous migration rate was 57.3 % (n = 43). In univariate analysis, pancreatitis, DB, TB, ALP, and stone size were significantly associated with spontaneous migration. However, in multivariate analysis, only pancreatitis (p = 0.007) and stone size (p = 0.007) remained significantly associated with spontaneous progression. ROC curve analysis revealed that stones <6 mm were associated with a higher likelihood of spontaneous migration (p = 0.001).
Conclusion:
A CBD stone size <6 mm may predict spontaneous migration in pediatric patients with choledocholithiasis. Therefore, this variable could help determine the likelihood of spontaneous migration and reduce the overuse of unnecessary, complex procedures in pediatric patients.
Level Of Evidence:
Level II, retrospective study.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
01:30Urinary Tract Calculi III: Medical Management
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
01:28Urinary Tract Calculi V: Nursing Management
01:28Urinary Tract Calculi I: Introduction