Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2015; 21(20): 6229-6235
Published online May 28, 2015. doi: 10.3748/wjg.v21.i20.6229
Cholangiographic characteristics of common bile duct dilatation in children
Seak Hee Oh, Soo-Hee Chang, Hyun Jin Kim, Jin Min Cho, Ji-Hee Hwang, Jung-Man Namgoong, Dae Yeon Kim, Young-Ah Cho, Chong Hyun Yoon, Kyung Mo Kim
Seak Hee Oh, Soo-Hee Chang, Hyun Jin Kim, Jin Min Cho, Kyung Mo Kim, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul 138-736, South Korea
Ji-Hee Hwang, Jung-Man Namgoong, Dae Yeon Kim, Department of Pediatric Surgery, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul 138-736, South Korea
Young-Ah Cho, Chong Hyun Yoon, Department of Pediatric Radiology, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul 138-736, South Korea
Author contributions: Oh SH and Kim KM wrote the manuscript and designed the study; all the others contributed in supplementing the manuscript.
Ethics approval: The study was approved by the Internal Review Board of Seoul Asan Medical Center (2014-0819).
Informed consent: Informed consent was obtained from the parents of all the patients prior to study enrollment.
Conflict-of-interest: There is no conflict of interest in the study.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kyung Mo Kim, MD, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, 388-1 Pungnap-Dong, Songpa-Gu, Seoul 138-736, South Korea. kmkim@amc.seoul.kr
Telephone: +82-2-30103380 Fax: +82-2-4733725
Received: September 21, 2014
Peer-review started: September 26, 2014
First decision: October 29, 2014
Revised: November 17, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: May 28, 2015
Processing time: 250 Days and 18.8 Hours
Abstract

AIM: To investigate whether children with congenital common bile duct dilatation (CBDD) differ from children with obstructive CBDD in cholangiographic characteristics.

METHODS: In this retrospective cohort study, the baseline data and the results of imaging analyses were reviewed among children who had endoscopic retrograde cholangiopancreatography (ERCP) due to CBDD. ERCP was performed on all pediatric patients by experienced pediatric endoscopists. The maximal transverse diameter of the common bile duct (CBD) was measured on ERCP. To assess whether age-adjusted CBDD could be used for differential diagnosis, a CBDD severity index (SI) was calculated by dividing the measured CBD diameter by the age-corrected maximal diameter of a normal CBD.

RESULTS: A retrospective medical chart review revealed that 85 consecutive children under 16 years of age with hepatobiliary disease and CBDD were referred to Seoul Asan Medical Center. Fifty-five (64.7%) children had congenital CBDD and 30 (35.3%) had obstructive CBDD. The two groups did not differ significantly in terms of clinical characteristics except for sex. The congenital and obstructive CBDD groups did not differ significantly in terms of mean CBD diameter (19.3 ± 9.6 mm vs 12.2 ± 4.1 mm, P > 0.05). However, congenital CBDD cases had a significantly higher mean SI than obstructive CBDD cases (3.62 ± 1.64 vs 1.98 ± 0.71, P = 0.01). In multivariate analysis, an SI value ≥ 2.32 and comorbidity with anomalous union of pancreaticobiliary duct (APBDU) in ERCP independently predicted congenital CBDD.

CONCLUSION: Measuring the CBD may aid the differential diagnosis of both CBDD and APBDU in children.

Keywords: Endoscopic retrograde cholangiopancreatography; Common bile duct; Choledochal cyst; Choledolithiasis; Children

Core tip: A severity index calculated by measuring the diameter of the common bile duct (CBD) adjusted for age was a better method to discriminate between congenital common bile duct dilatation (CBDD) and secondarily obstructive CBDD in children compared with simply measuring the diameter of the CBD.