A prospective multicenter analysis from the Pediatric ERCP Database Initiative: predictors of choledocholithiasis at ERCP in pediatric patients.

ABSTRACT Background and aims The management of suspected choledocholithiasis remains a challenge in pediatric endoscopy. Several recommendations are available for adult patients; however, it is unknown which pediatric patients are most likely to benefit from ERCP for evaluation of choledocholithiasis. The primary aim of this study was to evaluate adult-based criteria in the evaluation of pediatric patients with choledocholithiasis. A secondary aim was to evaluate the role of conjugated (or direct) bilirubin to improve the sensitivity of detecting choledocholithiasis. Methods This was a prospective multicenter study in pediatric patients as part of the Pediatric ERCP Database Initiative (PEDI) with additional post-hoc analysis of updated guidelines. Patients Results Ninety-five patients were enrolled (69 with choledocholithiasis confirmed at ERCP and 26 with no stones at ERCP). Adverse event rates were similar in both groups. Specificity ranged from 27% to 91% using adult guidelines, but a sensitivity of only 20% to 69%. The were no significant differences between the 2 groups using preprocedure transabdominal US (p=1.0). Significant differences between groups were identified using either the total or conjugated bilirubin (p=.02). There was also a significant difference between the stone and no-stone groups when conjugated bilirubin was dichotomized to > 2 mg/dL (p=.03). Conclusions Abdominal imaging and lab indices may be used to predict pediatric choledocholithiasis with varying sensitivity and specificity. Pediatric specific guidelines may allow for improved stone prediction compared with existing adult recommendations.