Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review.
Adolescent
Anti-Bacterial Agents
/ adverse effects
Cephalosporins
/ adverse effects
Child
Child, Preschool
Cholagogues and Choleretics
/ therapeutic use
Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy
Choledochal Cyst
/ complications
Conservative Treatment
Cross-Sectional Studies
Female
Follow-Up Studies
Gallstones
/ diagnosis
Humans
Incidence
Infant
Infant, Newborn
Male
Remission, Spontaneous
Retrospective Studies
Risk Factors
Taiwan
/ epidemiology
Ursodeoxycholic Acid
/ therapeutic use
choledochal cyst
cholestasis
gallstones
pediatrics
Journal
Pediatrics and neonatology
ISSN: 2212-1692
Titre abrégé: Pediatr Neonatol
Pays: Singapore
ID NLM: 101484755
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
26
03
2020
revised:
15
05
2020
accepted:
10
07
2020
pubmed:
11
8
2020
medline:
14
5
2021
entrez:
11
8
2020
Statut:
ppublish
Résumé
Gallstones are uncommon in infants and children and Asian children are thought to have very low risk. Diagnoses have increased in recent years with the widespread use of ultrasonography (USG). This study aimed to review our experience with risk factors, complications, and treatment of pediatric gallstones in low-incidence populations. We retrospectively reviewed patients younger than 18 years old diagnosed with gallstones using USG between November 2006 and December 2012 in a tertiary referral hospital in Taiwan. Demographic information including age and sex, follow-up period, USG findings, predisposing factors, complications, treatment approaches and outcomes were recorded. Ninety-eight children with gallstones diagnosed with USG were enrolled and reviewed in our study. Females comprised 55% of patients, with no specific gender tendency. No risk factor could be identified in 30.8% of patients. The most common risk factors were cephalosporin (CS) use, presence of a choledochal cyst (CC), and spherocytosis. CS use was not associated with a higher dissolution rate. The presence of type IVa CC implied a high rate of gallstone recurrence after Roux-en-Y hepaticojejunostomy. Complications were seen in 22.4% of patients, but only two needed emergency stone removal. Expectant management was performed in 61% of patients and 62.5% of them achieved spontaneous resolution; the stone dissolution rate was not lower than in the group treated with ursodeoxycholic acid (UDCA). Stone size was significantly decreased after UDCA use if resolution did not occur. Pediatric gallstones showed high resolution rate, and the clinical course was largely benign. CS use was the most common risk factor and did not predict a higher dissolution rate. Type IVa CC was also an important risk factor associated with a high recurrence rate. Conservative treatment and oral UDCA may be reasonable strategies in most patients, unless complications are present.
Sections du résumé
BACKGROUND
Gallstones are uncommon in infants and children and Asian children are thought to have very low risk. Diagnoses have increased in recent years with the widespread use of ultrasonography (USG). This study aimed to review our experience with risk factors, complications, and treatment of pediatric gallstones in low-incidence populations.
METHODS
We retrospectively reviewed patients younger than 18 years old diagnosed with gallstones using USG between November 2006 and December 2012 in a tertiary referral hospital in Taiwan. Demographic information including age and sex, follow-up period, USG findings, predisposing factors, complications, treatment approaches and outcomes were recorded.
RESULTS
Ninety-eight children with gallstones diagnosed with USG were enrolled and reviewed in our study. Females comprised 55% of patients, with no specific gender tendency. No risk factor could be identified in 30.8% of patients. The most common risk factors were cephalosporin (CS) use, presence of a choledochal cyst (CC), and spherocytosis. CS use was not associated with a higher dissolution rate. The presence of type IVa CC implied a high rate of gallstone recurrence after Roux-en-Y hepaticojejunostomy. Complications were seen in 22.4% of patients, but only two needed emergency stone removal. Expectant management was performed in 61% of patients and 62.5% of them achieved spontaneous resolution; the stone dissolution rate was not lower than in the group treated with ursodeoxycholic acid (UDCA). Stone size was significantly decreased after UDCA use if resolution did not occur.
CONCLUSIONS
Pediatric gallstones showed high resolution rate, and the clinical course was largely benign. CS use was the most common risk factor and did not predict a higher dissolution rate. Type IVa CC was also an important risk factor associated with a high recurrence rate. Conservative treatment and oral UDCA may be reasonable strategies in most patients, unless complications are present.
Identifiants
pubmed: 32773363
pii: S1875-9572(20)30106-6
doi: 10.1016/j.pedneo.2020.07.013
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Cephalosporins
0
Cholagogues and Choleretics
0
Ursodeoxycholic Acid
724L30Y2QR
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
598-605Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020. Published by Elsevier B.V.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors declare that they have no conflict of interest.