Endoscopic sphincterotomy in the management of bile duct stones in children.
OBJECTIVE
Endoscopic sphincterotomy (ES) is a widely accepted method of extracting bile duct stones (BDS) in young as well as in elderly patients. The present study was undertaken to assess the safety and efficacy of ES for the treatment of BDS in children, seven of whom were critically sick because of suppurative cholangitis or pancreatitis.


METHODS
Over a period of 33 months, ES was performed in 16 consecutive children aged 7-16 yr with BDS. Nine patients had gallbladder in situ, and seven had previously undergone cholecystectomy. The coexisting abnormalities were gallstones and hepatic duct stones in one patient each and dead fragmented roundworms in 11 patients. Seven (five with an intact gallbladder and two cholecystectomized) patients presented with severe complications of BDS such as severe cholangitis in six and acute severe pancreatitis in one.


RESULTS
ES was technically successful in all patients, and complete stone extraction was achieved in 15 (93.8%) patients. Complications were minor bleeding in one (6.3%) patient without mortality. One patient with coexisting gallstones underwent cholecystectomy at a later date. During a mean follow-up period of 4-32 months, one patient developed recurrent biliary symptoms because of biliary ascariasis.


CONCLUSIONS
We conclude ES is a safe and an effective method of treating BDS in children with previous cholecystectomy, and in those presenting with severe complications of BDS, such as pyogenic cholangitis or acute pancreatitis regardless of the presence of gallbladder.
Zargar
Showkat Ali
SA
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
Javid
Gul
G
Khan
Bashir Ahmad
BA
Yattoo
Ghulam Nabi
GN
Shah
Altaf Hussain
AH
Gulzar
Ghulam Mohammad
GM
Singh
Jaswinder
J
Rehman
Bilal-ul
BU
ud-din
Zia
Z
D000293:Adolescent; D002648:Child; D002758:Cholangiography; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome