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Rethinking Risk: Predictive Factors for Choledocholithiasis in Pediatric Patients
Sabrina Sedano1, Sarah L Maxwell2, Sue J Rhee2
1University of California, San Francisco, School of Medicine, San Francisco, California.
Insights
Pediatric choledocholithiasis risk increases with common bile duct (CBD) dilation ≥6 mm and total bilirubin ≥1.4 mg/dL. These factors help predict pediatric choledocholithiasis, guiding timely interventions.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Surgery
- Diagnostic Imaging
Background:
- Pediatric cholelithiasis and choledocholithiasis incidence are rising.
- Existing adult guidelines and pediatric DUCT criteria lack specific validation in pediatric populations.
- There is a need to identify predictive factors for choledocholithiasis in children.
Purpose of the Study:
- To identify independent predictive factors for pediatric choledocholithiasis.
- To determine optimal cutoff values for key predictive markers.
- To inform the development of pediatric-specific diagnostic tools.
Main Methods:
- Retrospective cohort study of children ≤18 years undergoing cholecystectomy (2018-2023).
- Exclusion of patients with cancer, chronic pancreatitis, or acalculous cholecystitis.
- Multivariable logistic regression analysis of demographic and clinical data, including common bile duct (CBD) size and total bilirubin.
Main Results:
- Common bile duct (CBD) size independently increased choledocholithiasis odds by 57% per 1 mm increase (P < 0.001).
- Total bilirubin independently increased choledocholithiasis odds by 21% per 0.1 mg/dL increase (P = 0.012).
- Optimal predictive cutoffs identified: CBD ≥6 mm (AUC: 0.87) and total bilirubin ≥1.4 mg/dL (AUC: 0.79).
Conclusions:
- Common bile duct dilation ≥6 mm is a significant predictor of pediatric choledocholithiasis.
- A total bilirubin level ≥1.4 mg/dL is also associated with increased risk.
- Findings support the need for a validated pediatric-specific tool to guide management and resource allocation.
Introduction:
Pediatric cholelithiasis incidence is increasing. Adult guidelines and the recently developed pediatric DUCT criteria aim to identify patients at risk for choledocholithiasis, but pediatric validation is lacking. This study aimed to identify predictive factors for pediatric choledocholithiasis.
Methods:
We conducted a retrospective cohort study of children ≤18 y undergoing cholecystectomy from January 1, 2018 to May 31, 2023 at an academic medical center. Patients with cancer, chronic pancreatitis, or acalculous cholecystitis were excluded. Demographic and clinical data were abstracted from electronic records. Choledocholithiasis was defined by positive intraoperative cholangiogram or endoscopic retrograde cholangiopancreatography detection of stones/sludge. Univariate analyses identified potential predictors, and multivariable logistic regression assessed independent associations controlling for age and sex. Receiver operating characteristic curves determined optimal cutoff values for total bilirubin and common bile duct (CBD) size.
Results:
Among 283 patients (median age 15 y, 74.7% female, 82.1% public insurance, 74.2% minority race/ethnicity), total bilirubin, alanine aminotransferase, aspartate aminotransferase, and sonographic CBD size were associated with choledocholithiasis on univariate analysis (P < 0.01). Multivariable analysis showed CBD size independently increased odds of choledocholithiasis by 57% per 1 mm (P < 0.001) and total bilirubin increased odds of choledocholithiasis by 21% per 0.1 mg/dL increase in bilirubin (P = 0.012). Optimal cutoffs were 6 mm CBD (area under curve: 0.87) and bilirubin of 1.4 mg/dL (area under curve: 0.79).
Conclusions:
CBD dilation ≥6 mm predicted choledocholithiasis, consistent with DUCT criteria, but a lower total bilirubin (≥1.4 mg/dL) was also associated with increased risk. These findings support the need for a validated pediatric-specific predictive tool to guide timely intervention and optimize resource use.
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