Clinical Utility of Definitive Diagnostic Tests for Choledocholithiasis in Pediatric Patients with Mild Gallstone Pancreatitis

Infographic · Nov 2023 · 1 min read

In brief

Study of 84 pediatric patients found that those with mild gallstone pancreatitis but no risk factors (elevated bilirubin, dilated bile duct, or ultrasound findings) had only 2.7% incidence of choledocholithiasis. Authors recommend skipping intraoperative cholangiography in low-risk patients undergoing cholecystectomy.

Pediatric gallstone pancreatitis without risk factors has very low CD incidence (2.7%), questioning routine definitive testing.
Risk factors (bilirubin ≥2 mg/dl, CBD >6mm, US-detected CD) have 97.3% negative predictive value for choledocholithiasis.
Laparoscopic cholecystectomy without IOC is appropriate for low-risk pediatric gallstone pancreatitis patients.
Only 15.5% of pediatric gallstone pancreatitis cases had confirmed CD on definitive testing (MRCP/ERCP/IOC).
Presence of risk factors increases CD detection from 2.7% to 25.5% in pediatric gallstone pancreatitis.

Written by the GCMD Library team from the infographic.

The infographic is divided into two main panels. The left panel features an illustration of a patient figure with a magnified view of the gallbladder and bile duct system, accompanied by icons representing diagnostic tests. The right panel displays a decision tree with three circular icons (prohibition sign, downward arrow, and X symbol) indicating risk stratification levels. Red accent colors highlight key decision points and the Buenos Aires location marker.

New infographic by Jose Campos and the Chilean Society of pediatric surgery

"Clinical Utility of Definitive Diagnostic Tests for Choledocholithiasis in Pediatric Patients with Mild Gallstone Pancreatitis"

Authors: Mauro Ariel Capparelli, Luciana Cotignola, María Victoria Domínguez, Pablo Damian D'Alessandro, Victor Hugo Ayarzabal, Marcelo Eugenio Barrenechea

Full article: https://gcmd.co/3MxARLj

Background

Gallstone pancreatitis was historically considered a risk factor for choledocholithiasis (CD). However, recent studies of adult patients evidenced a weak association between gallstone pancreatitis and CD. The aim of this study was to analyze this association in pediatric patients.

Methods

We conducted a retrospective study on patients with mild gallstone pancreatitis who underwent any definitive testing for CD (MRCP, ERCP, IOC), managed between March 2010 and September 2022. Patients were classified according to the presence or absence of risk factors for CD (total bilirubin ≥2 mg/dl; common bile duct >6 mm on ultrasound; and/or CD on ultrasound). We evaluated the diagnosis of CD on definitive testing in both groups and analyzed the predictive capacity of the presence of risk factors.

Results

Eighty-four patients were included in the final analysis. Seventy-nine percent were females. The median age was 13 (4–17) years. Forty-seven (55.9%) patients had one or more risk factors. The definitive testing confirmed 13 (15.5%) cases of CD, 12 (25.5%) in the group of patients with risk factors and 1 (2.7%) in those without risk factors. The sensitivity, specificity, positive predictive value and negative predictive value of the presence of associated risk factors were 92.3, 50.7, 25.5 and 97.3%, respectively.

Conclusion

Pediatric patients with gallstone pancreatitis without associated risk factors have a very low incidence of CD. In these patients we suggest performing a laparoscopic cholecystectomy without intraoperative cholangiography or any other definitive test for CD.

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