RT Journal
A1 Vrochides DV, Sorrells DL, Jr, Kurkchubasche AG, Wesselhoeft CW, Jr, Tracy TF, Jr, Luks FI
T1 IS there a role for routine preoperative endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis in children?
JF Archives of Surgery
JO Archives of Surgery
YR 2005
FD April 1
VO 140
IS 4
SP 359
OP 361
DO 10.1001/archsurg.140.4.359
UL http://dx.doi.org/10.1001/archsurg.140.4.359
AB Hypothesis 
    Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used preoperatively in adult patients with suspected choledocholithiasis. Cholelithiasis occurs much less often in children, and the indications for ERCP are not established. We hypothesized that the natural history of choledocholithiasis in children is spontaneous passage of stones through the papilla and that these children can be managed without routine preoperative ERCP.Design 
    Retrospective analysis of patients treated over a 10-year period.Setting 
    Tertiary care children’s hospital.Patients 
    All patients with cholecystectomy for biliary disease.Interventions 
    Cholecystectomy; intraoperative cholangiography for suspected choledocholithiasis: hyperbilirubinemia, gallstone pancreatitis, and ultrasonographic evidence of common bile duct dilation or common bile duct stones; and postoperative ERCP for symptomatic choledocholithiasis: pain and jaundice.Main Outcome Measures 
    Incidence and complications of choledocholithiasis and frequency of ERCP.Results 
    One hundred patients (63 females) were studied. Indications included acute cholecystitis (10%), chronic cholecystitis (59%), gallstone pancreatitis (26%), and choledocholithiasis (5%). An intraoperative cholangiography was performed in 45 patients, and common bile duct stones were identified in 13. Expectant management of asymptomatic common bile duct stones was associated with sonographic resolution within 1 week. One patient with intraoperative cholangiography–proven choledocholithiasis required ERCP for symptoms 24 hours after operation. One additional patient, who did not undergo intraoperative cholangiography, developed symptomatic choledocholithiasis and required ERCP. There were no choledocholithiasis- or ERCP-related complications.Conclusions 
    This study suggests that choledocholithiasis occurs frequently in children and that spontaneous passage of common bile duct stones is common. This could explain the relatively high incidence of gallstone pancreatitis. Conservative management of choledocholithiasis is successful in the majority of patients. Routine preoperative or postoperative ERCP is usually not indicated.