Evaluation for Fatty Liver Infiltration Should Become Standard in Pediatric Cholecystectomy Patients
Mary M Barron1, Lindsay H Devereux1, Nathan Dockery2
1Surgery, East Tennessee State University, Johnson City, USA.
Insights
Pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) is rising. Obese children with gallstones show higher fatty liver infiltration risk, suggesting ultrasound screening during gallbladder evaluation is crucial for early detection.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Medical Imaging
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing concern in children.
- Optimal detection methods for pediatric MASLD are not yet established.
- Children with cholelithiasis (gallstones) may have an increased risk of fatty liver infiltration.
Purpose of the Study:
- To investigate the prevalence of fatty liver infiltration in children undergoing cholecystectomy.
- To identify clinical indicators, particularly BMI, associated with fatty liver infiltration in this pediatric population.
- To explore the potential of ultrasound as a screening tool for MASLD in at-risk children.
Main Methods:
- Retrospective chart review of pediatric patients who underwent cholecystectomy over three years.
- Re-evaluation of ultrasounds by a pediatric radiologist to identify fatty liver infiltration.
- Analysis of data concerning Body Mass Index (BMI) and clinical indicators related to MASLD.
Main Results:
- 16% of the 62 included pediatric patients showed ultrasound evidence of fatty liver infiltration.
- Patients with fatty liver infiltration had a higher median weight percentage (98.7 vs. 94.5, p=0.0080).
- Obese or severely obese children had significantly higher alanine aminotransferase (ALT) levels (43 vs 16, p=0.0432).
Conclusions:
- Children with obesity are at increased risk for fatty liver infiltration and potentially MASLD.
- Ultrasound evaluation for liver pathology during gallbladder assessments is a simple, recommended intervention.
- This approach could facilitate early detection and management of pediatric MASLD.
Abstract:
Introduction Pediatric metabolic dysfunction-associated steatotic liver disease (MASLD) is rapidly becoming a health crisis. Despite clear benefits of recognition and treatment, optimal methods of detection have not been established. Children with known cholelithiasis may be at increased risk for fatty infiltration of their liver, presenting an opportunity for screening using ultrasound. Methods A retrospective chart review was conducted on children undergoing cholecystectomy at an institution in rural Appalachia over three years. A pediatric radiologist re-evaluated ultrasounds for fatty liver infiltration. Data were analyzed with respect to BMI. Clinical indicators associated with MASLD on the presence of fatty liver infiltration. Results Sixty-two patients met inclusion criteria; 10 had ultrasound evidence of fatty liver infiltration (16%) and they were more likely to have a higher median weight percentage (98.7 vs. 94.5, p=0.0080). Individuals who were obese or severely obese had a significantly higher blood alanine aminotransferase (ALT) than those who were not obese (43 vs 16, p=0.0432). Conclusion Our study provides evidence that children with obesity are at greater risk for developing fatty infiltration of the liver and potentially MASLD. Evaluating a patient's ultrasound for liver pathology at the time of gallbladder evaluation is a simple intervention that should become standard.
