Endoscopic retrograde cholangiography for pediatric choledocholithiasis: Assessing the need for endoscopic intervention

Table 1 Demographics of patients with suspected choledocholithiasis

Group number n		1	2	Total
		37	7	44
Mean age		14.5 (± 3.8)	14.5 (± 2.0)	14.5 (± 3.5)
Sex	Male	14	0	14
	Female	23	7	30
Ethnicity	White	4	2	6
	African-American	12	0	12
	Latino-Hispanic	20	5	25
	Other	1	0	1
Imaging	CBDS on US	16	0	16
	No CBDS on US	21	7	28
	CBDS on MRCP	6 of 8	3 of 6	9 of 14
Clinical	Gallstone pancreatitis	11	4	15

CBDS: Common bile duct stone; US: Ultrasound; MRCP: Magnetic resonance cholangiopancreatography.

Table 2 Univariate analysis of clinical parameters with interquartile ranges

	Combined group data median (IQR)	Group 1 median (IQR)	Group 2 median (IQR)
Age (yr)	15.8 (12.5, 17.3)	16.1 (12.2, 17.3)	14.8 (12.5, 15.4)
Time to procedure (d)	2 (1.0, 2.3)	2 (1.0, 2.0)	2 (1.0-3.0)
US CBD diameter (mm)	8.8 (6.8, 10.5)	9 (7.0, 11.0)	8 (6.1-10.0)
ERCP CBD diameter (mm)	11 (9.0, 13.0)	11 (9.3, 13)	9 (7.0, 10.0)
Total bilirubin (mg/dL)	2 (0.8, 3.6)	2.5 (0.9, 3.8)	0.9 (0.6-1.5)
Conjugated bilirubin (mg/dL)	1 (0.0-2.1)	1.3 (0.0, 2.4)	0 (0, 0)
ALT (u/L)	242 (142.5, 386.5)	253 (145.0, 403.0)	166 (122.0-166.0)
AST (u/L)	128 (86.0, 188.0)	129 (89.0, 215.0)	119 (53-150)
γGT (u/L)	259 (177.0, 453.5)	259 (181.0, 521.0)	203 (159.0-333)
Alkaline phosphatase (u/L)	252 (179.0, 349.0)	254 (182.0, 405.0)	208 (107.0-256.0)

Combined group data, Group 1 (patients with CBDS) and Group 2 (patients without CBDS). IQR: Interquartile range; CBD: Common bile duct; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; γGT: Gamma-glutamyl transferase; US: Ultrasound; ERCP: Endoscopic retrograde cholangiography.

Table 3 Univariate characteristics in the evaluation of choledocholithiasis

Criteria	Sensitivity% (95%CI)	Specificity% (95%CI)	PPV% (95%CI)	NPV% (95%CI)	Odds ratio (95%CI)	P-value
VS-PM	81.2 (64-91)	85.7 (42-99)	96.8 (81-100)	46.2 (20-74)	25.7 (2.65-249)	0.07
S-PM	59.5 (42-75)	85.7 (42-99)	95.7 (76-100)	28.6 (12-52)	8.8 (0.96-80.7)	0.001
VS-Adult	59.5 (42-75)	100 (56-100)	100 (81-100)	31.8 (15-55)	18.8 (0.96-80.7)	0.0001
S-Adult	48.6 (32-65)	85.7 (42-99)	94.7 (72-100)	24 (10-45)	5.68 (0.62-51.97)	0.0001
CBDS by US	43.2 (28-60)	100 (56-100)	100 (76-100)	25 (11-45)	14.57 (0.50-41.9)	0.0001
CBD > 6 mm	81.1 (64-91)	14.3 (1-58)	83.3 (67-93)	12.5 (1-33)	0.714 (0.074-6.92)	1
CBD > 8 mm	91.7 (76-98)	28.6 (5-70)	86.8 (71-95)	40 (7-83)	4.4 (0.58-33.2)	0.727
TB > 4.0	21.6 (10-39)	100 (56-100)	100 (60-100)	19.4 (8-37)	11.66 (0.17-15.82)	0.0001
TB ≥ 1.8	56.8 (41-71)	85.7 (49-97)	95.5 (75-100)	27.3 (12-50)	7.88 (0.86-72.12)	0.0001
CB ≥ 0.5	67.6 (50-81)	85.7 (42-99)	96.2 (78-100)	33.3 (14-59)	12.5 (1-115)	0.003
ALT > 300	56.8 (40-72)	14.3 (1-58)	77.8 (57-91)	5.9 (0-31)	0.219 (0.024-2.00)	0.052
ALT > 350	40.5 (26-57)	100 (56-100)	100 (80-100)	24.1 (11-42)	14.1 (0.45-37.5)	0.0001
AST > 155	43.2 (28-60)	85.7 (42-99)	94 (69-100)	22.2 (9-43)	4.57 (0.499-41.9)	0.0001
γGT > 400	35.1 (21-53)	100 (56-100)	100 (72-100)	22.6 (10-42)	13.25 (0.352-30.0)	0.0001

¹A zero denominator was substituted with a unit of one for odds ratio only. Includes sensitivity, specificity, positive predictive value, and odds ratio. P-values were calculated for each category for differences between patients with and without stones using McNemar’s test. PPV: Positive predictive value; NPV: Negative predictive value; VS-PM: Very Strong Pediatric “Modified”; S-PM: Strong Pediatric “Modified”; VS-Adult: Very Strong Adult; S-Adult: Strong Adult; CBDS: Common bile duct stone; CB: Conjugated bilirubin; TB: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; γGT: Gamma-glutamyl transferase; CBD: Common bile duct.