Influence of Stone Size on Spontaneous Migration of Choledocholithiasis in Pediatric Patients.

INTRODUCTION

The incidence of choledocholithiasis in pediatric patients with gallstones is higher than in adults (30 %). However, spontaneous migration is very common in these patients. To date, no pediatric studies have analyzed the relationship between stone size in the common bile duct (CBD) and spontaneous migration.

OBJECTIVE

To analyze the influence of stone size and characteristics in the CBD on the spontaneous migration of choledocholithiasis in pediatric patients.

MATERIALS AND

METHODS

We conducted a retrospective study of patients diagnosed with choledocholithiasis by ultrasound at the "Prof. Dr. Juan P. Garrahan" Hospital from January 2010 to December 2023. Demographic data (age, sex), laboratory findings [amylase/lipase, total and direct bilirubin (TB and DB), alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase (ALP), and gamma-glutamyl transpeptidase], and imaging findings (stone size, single or multiple stones, CBD diameter) were analyzed. Spontaneous migration was defined as the absence of CBD stones on confirmatory modalities: magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and/or intraoperative cholangiography.

RESULTS

A total of 110 patients with choledocholithiasis by ultrasound were reviewed. Patients with incomplete data on stone size (n = 35) were excluded, leaving 75 patients for final analysis. The mean age was 13 years (SD 2.3 years), and 74.6 % (n = 56) were female. Pancreatitis was associated in 30.6 % (n = 23) of cases. The spontaneous migration rate was 57.3 % (n = 43). In univariate analysis, pancreatitis, DB, TB, ALP, and stone size were significantly associated with spontaneous migration. However, in multivariate analysis, only pancreatitis (p = 0.007) and stone size (p = 0.007) remained significantly associated with spontaneous progression. ROC curve analysis revealed that stones <6 mm were associated with a higher likelihood of spontaneous migration (p = 0.001).

CONCLUSION

A CBD stone size <6 mm may predict spontaneous migration in pediatric patients with choledocholithiasis. Therefore, this variable could help determine the likelihood of spontaneous migration and reduce the overuse of unnecessary, complex procedures in pediatric patients.

LEVEL OF EVIDENCE: Level II, retrospective study.