Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review
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 pe...
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doaj-5d639c03b8754991a48e349d5fe9db2f2020-11-29T04:14:46ZengElsevierPediatrics and Neonatology1875-95722020-12-01616598605Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center reviewShu-Chao Weng0Hung-Chang Lee1Chun-Yan Yeung2Wai-Tao Chan3Hsi-Che Liu4Chuen-Bin Jiang5Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Taitung Mackay Memorial Hospital, Taitung County, TaiwanDepartment of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, TaiwanDepartment of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, TaiwanDepartment of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, TaiwanDepartment of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Hematology-Oncology, MacKay Children's Hospital, Taipei, TaiwanDepartment of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan; Corresponding author. No. 92, Sec. 2, Zhongshan N. Rd., Taipei City 10449, Taiwan. Fax: +886 2 2543 3642.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.http://www.sciencedirect.com/science/article/pii/S1875957220301066cholestasischoledochal cystgallstonespediatrics |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Shu-Chao Weng Hung-Chang Lee Chun-Yan Yeung Wai-Tao Chan Hsi-Che Liu Chuen-Bin Jiang |
spellingShingle |
Shu-Chao Weng Hung-Chang Lee Chun-Yan Yeung Wai-Tao Chan Hsi-Che Liu Chuen-Bin Jiang Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review Pediatrics and Neonatology cholestasis choledochal cyst gallstones pediatrics |
author_facet |
Shu-Chao Weng Hung-Chang Lee Chun-Yan Yeung Wai-Tao Chan Hsi-Che Liu Chuen-Bin Jiang |
author_sort |
Shu-Chao Weng |
title |
Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review |
title_short |
Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review |
title_full |
Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review |
title_fullStr |
Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review |
title_full_unstemmed |
Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review |
title_sort |
choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: a single-center review |
publisher |
Elsevier |
series |
Pediatrics and Neonatology |
issn |
1875-9572 |
publishDate |
2020-12-01 |
description |
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. |
topic |
cholestasis choledochal cyst gallstones pediatrics |
url |
http://www.sciencedirect.com/science/article/pii/S1875957220301066 |
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