Pediatric gallstone disease, postoperative outcomes, and endoscopic management: a single centre 5-year experience.

OBJECTIVES

Pediatric gallstone disease is increasing in incidence, possibly due to rising rates of childhood obesity. There are concerns about delayed presentations and the need for surgery and endoscopic management. The aim of this project is to assess rates of cholecystectomy in pediatrics, distribution of pathology, impact of body mass index (BMI), and need for endoscopic retrograde cholangiopancreatography (ERCP).

METHODS

We performed a retrospective cohort study of pediatric patients undergoing cholecystectomy and compared baseline characteristics and outcomes between different pathologies and between overweight (BMI ≥ 85th percentile) and normal weight cohorts.

RESULTS

A total of 210 patients were included with 108 (51.4%) undergoing elective gallbladder surgery, 35 (16.7%) undergoing emergent gallbladder surgery, and 67 (32.0%) requiring surgery for bile duct disease. Most were female (77.3%), overweight (69.9%), and adolescents (mean age 14.0 ± 2.9). Metabolic syndrome-associated steatotic liver disease was present in 5.3%, hereditary spherocytosis in 7.7%, and sickle cell disease in 1.4%. Thirty-eight required ERCP (18.1%). Patients presenting emergently had much longer lengths of stay than did those with elective admissions (median 3.0 ± 3.0 versus 0.0 ± 1.0 days, P < 0.001). Overweight patients more frequently experienced complications than the normal weight cohort (16% versus 7%, P = 0.044). Furthermore, length of stay (LOS) was also higher in the normal weight cohort than in the overweight group in elective biliary colic patients and emergent gallbladder patients (P = 0.007 and 0.042, respectively).

CONCLUSIONS

Gallstone disease in pediatrics often presents emergently. This is associated with worse outcomes such as prolonged LOS when compared with non-urgent cases. A significant proportion of patients present with common bile duct disease and require ERCP. Early diagnosis leading to surgical referral for patients with gallstone disease and multimodal strategies to decrease risk factors and expedite weight loss may help prevent complicated gallstone disease.