Endoscopic retrograde cholangiography for pediatric choledocholithiasis: Assessing the need for endoscopic intervention.
OBJECTIVE
To assess pediatric patients for choledocholithiasis. We applied current adult guidelines to identify predictive factors in children.


METHODS
A single-center retrospective analysis was performed at a tertiary children's hospital. We evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography (ERCP) for suspected choledocholithiasis. Patients were stratified into those with common bile duct stones (CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy (ASGE) guidelines (Very Strong and Strong criteria) for suspected CBDS.


RESULTS
CBDS were identified in 84% at the time of ERCP. Abdominal ultrasound identified CBDS in 36% of patients. Conjugated bilirubin ≥ 0.5 mg/dL was an independent risk factor for CBDS (P = 0.003). The Very Strong (59.5%) and Strong (48.6%) ASGE criteria identified the majority of patients (P = 0.0001). A modified score using conjugated bilirubin had a higher sensitivity (81.2% vs 59.5%) and more likely to identify a stone than the standard criteria, odds ratio of 25.7 compared to 8.8. Alanine aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25, respectively.


CONCLUSIONS
Current adult guidelines identified the majority of pediatric patients with CBDS, but specific pediatric guidelines may improve detection, thus decreasing risks and unnecessary procedures.
Douglas S Fishman, Bruno P Chumpitazi, Cynthia Man-Wai Tsai, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, United States.
Douglas S
DS
Fishman
Douglas S Fishman, Bruno P Chumpitazi, Cynthia Man-Wai Tsai, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, United States.
Bruno P
BP
Chumpitazi
Douglas S Fishman, Bruno P Chumpitazi, Cynthia Man-Wai Tsai, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, United States.
Isaac
I
Raijman
Douglas S Fishman, Bruno P Chumpitazi, Cynthia Man-Wai Tsai, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, United States.
Cynthia Man-Wai
CM
Tsai
Douglas S Fishman, Bruno P Chumpitazi, Cynthia Man-Wai Tsai, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, United States.
E O'Brian
EO
Smith
Douglas S Fishman, Bruno P Chumpitazi, Cynthia Man-Wai Tsai, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, United States.
Mark V
MV
Mazziotti
Douglas S Fishman, Bruno P Chumpitazi, Cynthia Man-Wai Tsai, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, United States.
Mark A
MA
Gilger
Abdominal ultrasound; Children; Choledocholithiasis; Endoscopic retrograde cholangiography; Endoscopy; Gallstones; Pediatric