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Pediatric gallstone disease, postoperative outcomes, and endoscopic management: a single centre 5-year experience
Sukhdeep Jatana1, Anastasia Sizov2, Uzair Jogiat1
1Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Insights
Pediatric gallstone disease is rising, often presenting emergently with longer hospital stays and more complications in overweight children. Early diagnosis and weight management are crucial for better outcomes.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Public Health
Background:
- Pediatric gallstone disease incidence is increasing, linked to rising childhood obesity rates.
- Delayed presentations and the need for surgical and endoscopic interventions are significant concerns.
Purpose of the Study:
- To assess cholecystectomy rates in pediatric patients.
- To analyze the distribution of gallstone pathologies.
- To evaluate the impact of body mass index (BMI) and the necessity of endoscopic retrograde cholangiopancreatography (ERCP).
Main Methods:
- Retrospective cohort study of pediatric patients undergoing cholecystectomy.
- Comparison of baseline characteristics and outcomes between different pathologies.
- Comparison between overweight (BMI ≥ 85th percentile) and normal weight cohorts.
Main Results:
- 210 pediatric patients included; 69.9% were overweight, and 77.3% were female.
- Emergent presentations correlated with significantly longer lengths of stay (LOS) (P < 0.001).
- Overweight patients experienced more complications (16% vs. 7%, P = 0.044), though LOS was higher in normal weight patients for specific emergent and elective cases.
Conclusions:
- Pediatric gallstone disease frequently presents emergently, leading to worse outcomes like prolonged LOS.
- A substantial number of patients require ERCP for common bile duct disease.
- Early diagnosis, surgical referral, and weight management strategies are vital to prevent severe gallstone disease in children.
Objectives:
Pediatric gallstone disease is increasing in incidence, possibly due to rising rates of childhood obesity. There are concerns about delayed presentations and the need for surgery and endoscopic management. The aim of this project is to assess rates of cholecystectomy in pediatrics, distribution of pathology, impact of body mass index (BMI), and need for endoscopic retrograde cholangiopancreatography (ERCP).
Methods:
We performed a retrospective cohort study of pediatric patients undergoing cholecystectomy and compared baseline characteristics and outcomes between different pathologies and between overweight (BMI ≥ 85th percentile) and normal weight cohorts.
Results:
A total of 210 patients were included with 108 (51.4%) undergoing elective gallbladder surgery, 35 (16.7%) undergoing emergent gallbladder surgery, and 67 (32.0%) requiring surgery for bile duct disease. Most were female (77.3%), overweight (69.9%), and adolescents (mean age 14.0 ± 2.9). Metabolic syndrome-associated steatotic liver disease was present in 5.3%, hereditary spherocytosis in 7.7%, and sickle cell disease in 1.4%. Thirty-eight required ERCP (18.1%). Patients presenting emergently had much longer lengths of stay than did those with elective admissions (median 3.0 ± 3.0 versus 0.0 ± 1.0 days, P < 0.001). Overweight patients more frequently experienced complications than the normal weight cohort (16% versus 7%, P = 0.044). Furthermore, length of stay (LOS) was also higher in the normal weight cohort than in the overweight group in elective biliary colic patients and emergent gallbladder patients (P = 0.007 and 0.042, respectively).
Conclusions:
Gallstone disease in pediatrics often presents emergently. This is associated with worse outcomes such as prolonged LOS when compared with non-urgent cases. A significant proportion of patients present with common bile duct disease and require ERCP. Early diagnosis leading to surgical referral for patients with gallstone disease and multimodal strategies to decrease risk factors and expedite weight loss may help prevent complicated gallstone disease.
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