Is There a Role for ERCP in the Management of Gallstone Pancreatitis in Children? A Western Pediatric Surgery Research Consortium Study

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BACKGROUND: Guidelines for adult gallstone pancreatitis (GP) in adults recommend endoscopic retrograde cholangiopancreatography (ERCP) for ongoing biliary obstruction. Studies in children are limited by small sample sizes. We sought to explore whether factors predictive of choledocholithiasis (CDL) are correlated with ERCP findings of stones in pediatric GP. METHODS: We analyzed a subgroup of GP patients from a retrospective pediatric cohort undergoing cholecystectomy across ten hospitals from 2016 to 2019. Those with incomplete records and cholangitis were excluded. The absence of CDL was defined as ERCP that was either negative or not performed because of the resolution of obstruction. Comparative analyses were made between ERCP and non-ERCP patients. RESULTS: Among 1601 children undergoing cholecystectomy, 125 with GP were identified of which 30 (24 %) underwent preoperative ERCP. ERCP patients had a greater mean bilirubin (4.1 vs. 2.4, p = 0.02), median CBD diameter (9 vs. 5 mm, p <0 .001), and visualized stone on MRCP (36.7 vs. 4.2 %, p < 0.001). However, among patients with hyperbilirubinemia (≥1.8 mg/dL) or a dilated CBD (≥6 mm), 71 % of patients did not have CDL. In contrast, only 40 % of patients with a visualized stone on MRCP had a negative ERCP. ERCP was not associated with prolonged length of stay (LOS) or readmissions. CONCLUSION: In children with GP, hyperbilirubinemia and CBD dilation were not reliable predictors of a positive ERCP, potentially leading to unnecessary radiation and/or anesthesia. MRCP with visualized stone was the best predictor of CDL. Although ERCP did not result in greater LOS or readmissions, the use of MRCP prior to ERCP may reduce unnecessary procedures for children with gallstone pancreatitis.

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