Pediatric gallstone disease—Management difficulties in clinical practice

Background

Gallstone disease (GD) is no longer an exclusive condition of adulthood, and its prevalence is increasing in pediatric age. The management and the extent of the etiological investigation of GD in children and adolescents remains controversial. This study aimed to analyze the difficulties in the work-up and management of pediatric GD patients.

Methods

A retrospective study performed in a single tertiary center enrolled sixty-five patients with GD followed from January 2014 to June 2021. Patients were categorized conveniently according to their age at diagnosis: Group A (<10 years, n = 35) and Group B (≥10 years, n = 30). We analyzed demographic, clinical and laboratory data, ultrasonographic findings at presentation, therapeutics and complications.

Results

Symptoms were more frequent in patients >10 years old (p = 0.001). Cholecystectomy was performed in 31 patients (47.7%). A multivariate regression logistic model identified the age >10 years (OR = 6.440, p = 0.005) and underlying entities (OR = 6.823, p = 0.017) as independent variables to perform surgery. Spontaneous resolution of GD was more common in children <2 years old. A multivariate regression logistic model showed a trend for those >10 years old to develop more complications. Two out of 18 patients were diagnosed with ABCB4 gene mutations in heterozygosity.

Conclusions

Decision-making on cholecystectomy remains challenging in asymptomatic patients. Identifying predictive factors for the development of complications has proven difficult. However, we found a trend toward the development of complications in individuals older than 10 years.