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Yan et al. BMC Pediatrics (2023) 23:266
https://doi.org/10.1186/s12887-023-03994-3 BMC Pediatrics
†Jiayu Yan, Chuankai Lv, Dan Zhang and Mingkang Zheng
contributed equally to this work.
*Correspondence:
Xiaoman Wang
pcchty@yeah.net
Yajun Chen
chenyajunmd@126.com
Full list of author information is available at the end of the article
Abstract
Objective The purpose of this study was to analyze the outcomes of the combination of ultrasound (US)-guided
percutaneous external drainage and subsequent definitive operation to manage complicated choledochal cyst in
children.
Methods This retrospective study included 6 children with choledochal cyst who underwent initial US-guided
percutaneous external drainage and subsequent cyst excision with Roux-en-Y hepaticojejunostomy between
January 2021 and September 2022. Patient characteristics, laboratory findings, imaging data, treatment details, and
postoperative outcomes were evaluated.
Results Mean age at presentation was 2.7 ± 2.2 (0.5–6.2) years, and 2 patients (2/6) were boys. Four patients
(4/6) had a giant choledochal cyst with the widest diameter of ≥ 10 cm and underwent US-guided percutaneous
biliary drainage on admission or after conservative treatments. The other 2 patients (2/6) underwent US-guided
percutaneous transhepatic cholangio-drainage and percutaneous transhepatic gallbladder drainage due to
coagulopathy, respectively. Five patients (5/6) recovered well after US-guided percutaneous external drainage and
underwent the definitive operation, whereas 1 patient (1/6) had liver fibrosis confirmed by Fibroscan and ultimately
underwent liver transplantation 2 months after external drainage. The mean time from US-guided percutaneous
external drainage to the definitive operation was 12 ± 9 (3–21) days. The average length of hospital stay was 24 ± 9
(16–31) days. No related complications of US-guided percutaneous external drainage occurred during hospitalization.
At 10.2 ± 6.8 (1.0–18.0) months follow-up, all patients had a normal liver function and US examination.
Management of complicated choledochal cyst
in children: ultrasound-guided percutaneous
external drainage and subsequent denitive
operation
Jiayu Yan1†, Chuankai Lv1†, Dan Zhang1†, Mingkang Zheng3†, Chunhui Peng1, Wenbo Pang1, Wei Chen1, Siwei Wang2,
Xiaoman Wang2* and Yajun Chen1*
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Page 2 of 10
Yan et al. BMC Pediatrics (2023) 23:266
Background
Choledochal cyst, a relatively uncommon congenital mal-
formation characterized by biliary tract dilatation with an
incidence of around 1:13,000 in Asian populations versus
1:100,000 in Western populations, often presents with
abdominal pain, abdominal lump, and jaundice in pedi-
atric patients [1–3]. e currently acknowledged etiology
of choledochal cyst is the anomalous pancreaticobiliary
junction with reflux of pancreatic juice into the common
bile duct and the formation of protein plugs or calculi in
the bile duct [4, 5]. Given that patients with choledochal
cyst have a high risk of hepatobiliary complications,
such as cholangitis, pancreatitis, perforation of the cyst,
and potential malignant change, prompt treatment is
required [1, 6, 7]. Some studies have reported that even if
patients are asymptomatic, surgical intervention as soon
as possible can lead to a better outcome, such as a signifi-
cantly reduced rate of liver fibrosis in patients [3, 8]. e
specific approach is largely a function of the type of cyst
and the preferred treatment is total cyst excision with
Roux-en-Y hepaticojejunostomy [8, 9]. However, surgical
intervention should be elective, some related concomi-
tant complications, including cholangitis, pancreatitis,
and coagulopathy, may require conservative treatments,
delay the surgical treatments, and become the major
risk for operation [10–12]. How to address complicated
choledochal cyst has always been challenging in clinical
management.
Patients with complicated choledochal cyst often had a
distal biliary obstruction that led to bile stasis and ulti-
mately developed severe complications, such as acute
Conclusions Our detailed analysis of this small cohort suggests that US-guided percutaneous external drainage is
technically feasible for choledochal cyst with giant cysts or coagulopathy in children, which may provide suitable
conditions for subsequent definitive operation with a good prognosis.
Trial registration Retrospectively registered.
Keywords Choledochal cyst, Ultrasound, Percutaneous external drainage, Definitive operation
Fig. 1 Flow diagram of the study population
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Yan et al. BMC Pediatrics (2023) 23:266
cholangitis, abnormal liver function, and even perfora-
tion of choledochal cysts and coagulopathy [11–13].
ese patients commonly required two-stage operations,
urgent external biliary drainage, and subsequent defini-
tive operation [12, 14, 15]. e methods of external
drainage mainly included biliary drainage of extrahepatic
cyst or intrahepatic bile duct, and gallbladder drain-
age (cholecystostomy) [11, 15–17]. In most pediatric
cases, traditional external drainage was accomplished
by laparotomy or laparoscopic-assisted [11, 12, 18].
Percutaneous external drainage of choledochal cyst in
children has been rarely reported in the literature, and
ultrasound (US)-guided percutaneous external drainage
is even rarer [11, 15].
is study aimed to report the early clinical experience
of the combination of US-guided percutaneous external
drainage and subsequent definitive operation to manage
choledochal cyst in children in a small cohort and evalu-
ate its safety and effect.
Fig. 2 CT or MRCP, and US results of patients with choledochal cyst before and during US-guided percutaneous external drainage. (A) CT before US-
guided PBD, Case 1 with a giant choledochal cyst. (B) US-guided PBD, Case 1 with a giant choledochal cyst. (C) MRCP before US-guided PTCD, Case 5 with
significant dilatation of the intrahepatic bile duct. (D) US-guided PTCD, Case 5 with significant dilatation of the intrahepatic bile duct. (E) MRCP before
US-guided PTGD, Case 6 with a large gallbladder. (F) US-guided PTGD, Case 6 with a large gallbladder
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Yan et al. BMC Pediatrics (2023) 23:266
Methods
Patients
is retrospective study was approved by the Ethics Com-
mittee of Beijing Children’s Hospital (Approval number:
2022-E-214-R) and the need for informed consent was
waived. e medical records of patients diagnosed with
choledochal cyst and admitted to the department of gen-
eral surgery, Beijing Children’s Hospital, from January
2021 to September 2022, were reviewed. e diagnosis of
choledochal cyst was based on abdominal US with com-
puted tomography (CT) or magnetic resonance cholan-
giopancreatography (MRCP). Patients who underwent
US-guided percutaneous external drainage and subse-
quent definitive operation (cyst excision with Roux-en-
Y hepaticojejunostomy) were included in this study. e
exclusion criteria were as follows: (I) underwent surgery
at other hospitals before admission; (II) underwent the
definitive operation at our center before 2021; (III) no
definitive operation; (IV) underwent one-stage definitive
operation; and (V) underwent traditional open external
drainage and definitive operation (Fig.1).
Clinical characteristics
Two pediatric surgeons reviewed the electronic medical
records (JYY and MKZ). Patient characteristics, labo-
ratory findings, imaging data, treatment details, and
postoperative outcomes were analyzed. Patient charac-
teristics included sex, age, presenting symptoms, features
of the choledochal cyst (types and size), and preoperative
hepatobiliary complications. e types of choledochal
cyst were defined using Todani’ s classification, and the
choledochal cyst with a maximum diameter of ≥ 10 cm
was defined as a giant cyst [19, 20]. e laboratory find-
ings included the laboratory results before US-guided
percutaneous external drainage and before the definitive
operation, covering blood routine, coagulation biomark-
ers, liver function tests and indicators of pancreatitis.
e normal reference intervals for laboratory results in
our study were based on the PRINCE study [21]. Fibrino-
gen (FIB) level < 2g/L with prolonged prothrombin time
(PT) or activated partial thromboplastin time (APTT)
indicated coagulopathy [12, 22]. e value of aspartate
Table 1 Patients and characteristics
Cases Sex Age
(years)
Types Size
(cm3)
Preoperative complications Main indica-
tion for exter-
nal drainage
Procedures Denitive
procedures*Follow-
up
(months)
1 M 1.4 IVa 15.2*12.6*9.4 Coagulopathy, abnormal liver
function, liver fibrosis
Giant cyst,
coagulopathy
US-guided PBD,
local anesthesia
Liver
transplantation
18.0
2 F 0.5 Ia 20.0*11.2*8.2 Abnormal liver function Giant cyst US-guided PBD,
general anesthesia
Open 16.0
3 F 6.2 Ia 13.1*5.3*4.9 Abnormal liver function Giant cyst US-guided PBD,
general anesthesia
Robotic 8.5
4 M 0.9 IVa 10.5*6.6*4.7 Coagulopathy Giant cyst,
coagulopathy
US-guided PBD,
general anesthesia
laparoscopic 4.1
5 F 3.2 IVa 5.0*2.1*2.1 Coagulopathy, abnormal liver
function, acute pancreatitis
Coagulopathy US-guided PTCD,
general anesthesia
laparoscopic 13.6
6 F 3.8 Ic 1.3** Coagulopathy, abnormal liver
function, acute pancreatitis
Coagulopathy US-guided PTGD,
local anesthesia
laparoscopic 1.0
M: Male; F: Female; US: Ultrasound; PBD: Percutaneous biliary drainage; PTCD: Percutaneous transhepatic cholangio-drainage; PTGD: Percutaneous transhepatic
gallbladder drainage
* Except for li ver transpl antation, th e procedur e perfo rmed for pa tients wit h choledo chal cys t in our depar tment was c yst excisi on with Rou x-en-Y hepat icojejunos tomy
** The maximum d iameter of the cyst in Ic t ype of choledoch al cyst
Fig. 3 Operating instruments in US-guided percutaneous external drainage. (A) Ultrasound probes. (B) Mini-invasive kits of puncture, including puncture
needle, sharp knife, tract dilator, guide wire, Pig-tail catheter, and external fixator. (C) The method of external fixation
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Yan et al. BMC Pediatrics (2023) 23:266
aminotransferase (AST) and alanine aminotransfer-
ase (ALT) > 45 U/L with γ-glutamyl transpeptidase
(γ-GGT) > 70 U/L indicated abnormal liver function [23].
Acute pancreatitis was characterized by abdominal pain
and elevated serum amylase (AMY) and lipase (LPS) lev-
els (> 2 times the upper limit of reference interval) [24].
In addition, for patients with features of liver parenchy-
mal disease indicated by US, the degree of liver fibrosis
would be evaluated by Fibroscan, and the value of liver
stiffness measurement > 15.15kPa indicated liver fibrosis
in patients [20, 25].
e imaging data included the images of US, CT, and
MRCP performed at our center, including images dur-
ing US-guided percutaneous external drainage. e
treatment details had three aspects: conservative, inter-
ventional, and surgical treatments. e conservative
treatments of each patient were based on the laboratory
results on admission, mainly including nil-per-os, soma-
tostatin injected with a microinfusion pump (3.5 µg/
kg/h), intravenous omeprazole (1–2 mg/kg), antibiotic
treatment, and total parenteral nutrition. Telephone
interviews were performed in October 2022 to ask the
patients’ parents about the child’s prognosis and postop-
erative complications.
Ultrasound-guided percutaneous external drainage
e decision to perform external drainage was based
on the patients’ laboratory and imaging results (CT or
MRCP). If a patient had a giant cyst with abnormal liver
function or especially coagulopathy and did not improve
after conservative treatments, US-guided percutaneous
external drainage would be considered. Every patient
fasted for a minimum of 6h and was re-evaluated by US
to determine the extent of intrahepatic bile duct dilation,
the size of extrahepatic cyst and gallbladder to help select
the specific methods of external drainage. e US-guided
percutaneous external drainage was performed by a
pediatric radiologist (CKL) with more than 5 years of
experience in interventional US techniques, after obtain-
ing informed consent from the parents of patients. e
preferred method was US-guided percutaneous biliary
drainage (PBD), especially for patients with a giant extra-
hepatic cyst. In addition, US-guided percutaneous tran-
shepatic cholangio-drainage (PTCD) was performed in
patients with a small extrahepatic cyst, but significant dil-
atation of the intrahepatic bile duct, and US-guided per-
cutaneous transhepatic gallbladder drainage (PTGD) was
performed in patients with a large gallbladder (Fig.2).
All procedures are accomplished under general anes-
thesia by anesthesiologists or local anesthesia with the
support of oral chloral hydrate as a sedating agent by
continuous close monitoring, including the preparation
of emergency medications and oxygen therapy devices.
At the supine position, the right upper quadrant of
patients was draped in a sterile manner. Lidocaine (2%)
was used as a local anesthetic. First, after the puncture
point was determined by ultrasound and the skin was cut
through by a sharp scalpel, the right position of the punc-
ture needle was ensured by real-time US guidance and
introduced guide wire. is process should be far away
from the abdominal organs and blood vessels as possible.
Second, after the puncture, tract dilation was done under
real-time US guidance. Finally, a Pig-tail catheter (6–8 Fr)
was inserted along the introduced guide wire to decom-
press the biliary system, and the external fixation to the
skin was made (Fig. 3). In US-guided PBD, the point
at the anterior axillary line with the smallest distance
between the cyst and abdominal wall was selected as
the puncture point. In US-guided PTCD and US-guided
PTGD, the puncture needle was passed through the liver
to penetrate the target intrahepatic bile duct or gallblad-
der without touching the intrahepatic blood vessels.
Fig. 4 Images of biliar y drain after US-guided PBD. (A) Axial T2-weighted MR image after US-guided PBD, Case 2. (B) Coronal T2-weighted MR image after
US-guided PBD, Case 2. (C) MRCP image after US-guided PBD, Case 2
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Yan et al. BMC Pediatrics (2023) 23:266
After external drainage, conservative treatments were
performed, including intravenous broad-spectrum anti-
biotics and hemostatic agents, and patients resumed oral
intake as soon as possible to avoid electrolyte distur-
bances. Laboratory tests were performed on the 1st, 3rd,
and 7th day after external drainage to check the improve-
ment of the liver and coagulation function. Once needed,
patients were re-examined every 7 days until the liver and
coagulation function was appropriate for definite surgery.
Usually in our center, CT or MRCP would be repeated
prior to the definitive operation (Fig.4).
Data analysis
Continuous variables were expressed as the mean and
SD with ranges. Categorical variables were expressed as
numbers and proportions.
Results
During the study period, 6 patients with choledochal cyst
were treated by a combination of US-guided percutane-
ous external drainage and subsequent definitive opera-
tion, and their clinical characteristics were provided in
Table1. e mean age at presentation was 2.7 ± 2.2 (0.5–
6.2) years, and 2 patients (2/6) were boys. eir most
common presenting symptoms were jaundice (5/6) and
abdominal pain (3/6). Except for case 1, other patients
Fig. 5 Clinical diagnosis and treatment timelines of patients with choledochal cyst who underwent US-guided percutaneous external drainage and
subsequent definitive operation
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Yan et al. BMC Pediatrics (2023) 23:266
Table 2 Results of laboratory tests in 6 patients*
Case CRP
(mg/L)
WBC
(109/L)
FIB
(g/L)
PT
(S)
APTT
(S)
NH3
(umol/L)
AST
(U/L)
ALT
(U/L)
γ-GGT
(U/L)
DBIL
(umol/L)
IBIL
(umol/L)
AMY
(U/L)
LPS
(U/L)
Reference interval <10.0 4.4–11.9 2.0–4.0 9.4–2.5 25.1–38.4 18.0–72.0 14.0–44.0 7.0–30.0 5.0–19.0 0.0-3.42 0.0-17.1 0.0-125.0 0.0–
39.0
Case 1
Before external drainage 15.0 9.9 1.9 17.9 34.8 115.0 250.6 141.7 245.8 144.7 49.6 81.0 144.4
Pre-operation** <10.0 5.5 1.7 17.0 37.1 80.0 181.4 83.0 90.4 45.1 25.6 11.0 6.0
Case 2
Before external drainage <10.0 11.0 3.3 18.7 34.7 —— 354.5 278.1 1751.9 40.1 12.4 31.0 206.8
Pre-operation <10.0 7.16 —— —— —— —— 40.1 27.2 336.2 2.8 9.6 —— ——
Case 3
Before external drainage <10.0 9.0 3.4 9.2 35.2 —— 557.0 615.9 1542.0 55.0 17.3 74.0 ——
Pre-operation <10.0 9.7 —— —— —— —— 132.0 133.0 265.2 9.7 15.3 106 ——
Case 4
Before external drainage <10.0 18.4 1.9 117.4 172.0 32.0 93.1 42.2 60.2 100.8 35.9 —— ——
Pre-operation <10.0 9.0 1.9 11.2 45.0 —— 75.7 23.9 28.5 103.9 43.0 —— ——
Case 5
Before external drainage <10.0 9.4 0.3 21.5 32.2 68.0 254.0 284.7 748.9 96.0 38.2 1330.0 382.5
Pre-operation <10.0 5.7 2.0 14.8 35 83.0 33.9 52.7 362.1 9.2 19.5 115.0 27.5
Case 6
Before external drainage <10.0 11.1 1.7 30.7 45.6 —— 265.4 210.2 597.4 133.8 55.3 365.0 1929.2
Pre-operation <10.0 6.86 2.1 10.9 36.0 —— 60.7 33.3 74.2 5.9 21.0 57.0 30.5
CRP: C-reactive protein; WBC: White blood cell; FIB: Fibrinogen; PT: Prothrombin time; APTT: Activated partial thromboplastin time; NH3: Ammonia; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; γ-GGT:
γ-glut amyl transpeptidase; D BIL: Direct biliru bin; IBIL: Indirect b ilirubin; AMY: Amylase; LPS: Lipas e
* Numbers in b old indicated higher t han the upper limit of refe rence interval
** The laboratory results re-examined in 21 days after ultrasound-guided percutane ous external drainage
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Yan et al. BMC Pediatrics (2023) 23:266
visited our center within 1 month of presenting symp-
toms (Fig.5).
According to the laboratory and imaging results, the
main indications for US-guided percutaneous external
drainage were giant cyst and coagulopathy. Four patients
(4/6, Cases 1–4) had a giant choledochal cyst and under-
went US-guided PBD on admission or after conserva-
tive treatments. e size of their cysts decreased after
US-guided PBD (Fig.6). e other 2 patients (2/6, Cases
5 and 6) underwent US-guided PTCD and US-guided
PTGD due to coagulopathy, respectively (Table 2). Of
these patients, 4 patients (4/6, Cases 2–5) underwent
external drainage under general anesthesia, and another 2
(2/6, Cases 1 and 4) under local anesthesia. Five patients
(5/6) recovered well after external drainage and subse-
quently underwent the definitive operation, whereas 1
patient (1/6, Case 1) was considered to have liver fibrosis
with the value of liver stiffness measurement of 58.8kPa
by Fibroscan 21 days after external drainage and ulti-
mately underwent liver transplantation in another hos-
pital 2 months after external drainage. e mean time
from US-guided percutaneous external drainage to the
definitive operation was 12 ± 9 (3–21) days. e average
length of hospital stay was 24 ± 9 (16–31) days. No infec-
tion, electrolyte disturbance, and other complications
of US-guided percutaneous external drainage occurred
during hospitalization. At 10.2 ± 6.8 (1.0–18.0) months
follow-up, all patients had a normal liver function and US
examination.
Discussion
e study demonstrated the feasibility of the combina-
tion of US-guided percutaneous external drainage and
subsequent cyst excision with Roux-en-Y hepaticojeju-
nostomy to manage the complicated choledochal cyst
in children, especially for choledochal cyst with giant
cysts or coagulopathy, although the applicable conditions
should be further studied given the small sample size of
patients.
Early cyst excision has been recommended for chil-
dren with choledochal cyst to reduce the risk of long-
term complications, such as biliary infections and cancer
development [26–28]. Moreover, with the improvement
of perioperative management and surgical techniques,
most patients can undergo one-stage definitive operation
[29, 30]. However, in some cases, severe common bile
duct (CBD) dilatation, liver dysfunction, or coagulopa-
thy due to biliary obstruction still leads to high surgical
risk [12, 18]. Severe CBD dilatation often suggests the
presence of CBD stenosis. It can be accompanied by bile
duct inflammation, which will lead to repeated infection
before the definitive operation, increase the difficulty of
surgical operations, and have a high potential for anasto-
motic leakage during the primary closure [29, 31]. Liver
dysfunction and coagulopathy also have a higher risk of
anesthesia, intraoperative bleeding, and postoperative
disseminated intravascular coagulation. erefore, timely
external drainage is still essential for complicated chole-
dochal cyst [10, 11].
US is a good method to diagnose biliary diseases,
including choledochal cyst, and US-guided percutane-
ous external drainage has been widely used in adult bili-
ary disorders, such as acute cholecystitis, but few studies
have reported its application in pediatric patients [8,
32]. Compared with fluoroscopy-guided external drain-
age, US-guided percutaneous external drainage can
avoid unnecessary radiation exposure and reduce vascu-
lar injury during operation to prevent bleeding [15, 16].
However, visualization of the bile duct cannot be fully
realized by US, so we suggest that cholangiography, CT,
or MRCP should be performed consequently before the
Fig. 6 The size of choledochal cyst before and after US-guided percutaneous external drainage. (A) CT before US-guided PBD, Case 4. (B) CT after US-
guided PBD, Case 4
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Yan et al. BMC Pediatrics (2023) 23:266
definitive operation to understand the morphologic fea-
tures of the whole biliary tract and to check the loca-
tion of the drainage catheter [16]. In addition, in this
small cohort study, we found that patients could undergo
appropriate external drainage (PBD, PTCD or PTGD)
according to the extent of intrahepatic bile duct dilation,
the size of extrahepatic cyst and gallbladder re-evaluated
by US before external drainage, which had not been
reported in previous studies. However, US is a very user-
dependent imaging modality, and proper skills and rich
experience of the radiologists are required to ensure the
safety of patients, which is why US-guided percutaneous
external drainage is not widely used in pediatric patients
[33].
For patients with complicated choledochal cyst, US-
guided percutaneous external drainage is minimally
invasive and effective in relieving the symptoms of bili-
ary obstruction, but it also has risks of electrolyte distur-
bance and infection [11, 16, 18]. It has been reported that
the coagulation function of patients with choledochal
cyst improved significantly 7 days after external drainage
[12]. Cases 4–6 in our study with coagulopathy on admis-
sion were improved after US-guided percutaneous exter-
nal drainage. To reduce the associated complications of
US-guided percutaneous external drainage, all patients
underwent the definitive operation within 21 days after
external drainage during one hospitalization. If the liver
and coagulation function of patients cannot be improved
after US-guided percutaneous external drainage, the
existence of liver fibrosis should be considered, which
indicates a poor prognosis after the definitive operation;
in such cases, further liver transplantation should be per-
formed [34]. In our study, Case 1 presented symptoms in
the infantile period, had already developed liver fibrosis
on admission with a long-time biliary obstruction, and
ultimately underwent liver transplantation. erefore,
US-guided percutaneous external drainage can help
identify such cases. Similar to previous studies, early sur-
gical intervention was recommended for all patients once
a choledochal cyst was identified [1, 8, 12, 28, 34].
Many studies have shown that minimally invasive oper-
ations, including laparoscopic- or robot-assisted, have
obvious advantages in treating choledochal cysts [1, 35,
36]. For complicated choledochal cyst, compared with
traditional open external drainage, US-guided percuta-
neous external drainage can ensure minimally invasive
treatment of the entire process. e giant choledochal
cyst was conventionally treated by laparotomy, but in our
study, except for Case 2, all subsequent patients under-
went minimally invasive operations [18, 20]. is sug-
gests that minimally invasive operation after US-guided
percutaneous external drainage is safe and feasible for
complicated choledochal cyst.
is study was limited by the small sample of patients,
the isolated use of ultrasound, and the lack of a control
group. Based on the present findings and the absence of
a control group, it is not possible to prove the superiority
of US-guided percutaneous external drainage over simple
conservative treatments for patients with complicated
choledochal cyst. erefore, to what extent complicated
choledochal cyst should be performed US-guided percu-
taneous external drainage before the definitive operation
needs further studies. Further accumulation of cases is
expected in the future.
Conclusions
Our detailed analysis of this small cohort suggests that
US-guided percutaneous external drainage is technically
feasible for choledochal cyst with giant cysts or coagu-
lopathy in children, which may provide suitable condi-
tions for subsequent definitive operation and has a good
prognosis.
Abbreviations
US ultrasound
CT computed tomography
MRCP magnetic resonance cholangiopancreatography
M male
F female
PBD percutaneous biliary drainage
PTCD percutaneous transhepatic cholangio-drainage
PTGD percutaneous transhepatic gallbladder drainage
CRP C-reactive protein
WBC white blood cell
FIB fibrinogen
PT prothrombin time
APTT activated partial thromboplastin time
NH3 ammonia
AST aspartate aminotransferase
ALT alanine aminotransferase
γ-GGT γ-glutamyl transpeptidase
DBIL direct bilirubin
IBIL indirect bilirubin
AMY amylase
LPS lipase
CBD common bile duct
Acknowledgements
We would like to thank Yueping Zeng for assistance in retrieving the hospital/
medical record numbers for the electronic patient records needed for data
collection and all patients and their families for providing clinical data for this
study.
Author contributions
Conceptualization: JYY, CKL. Study design: JYY, CKL, DZ, XMW, YJC. Execution:
JYY, CKL, DZ, CHP, WBP, WC, SWW. Acquisition of the data: JYY, MKZ. Analysis
and interpretation: JYY, CKL, DZ, MKZ. Writing: JYY, CKL, DZ, MKZ. Review and
editing: JYY, CKL, DZ, MKZ, CHP, WBP, WC, SWW, XMW, YJC. The author(s) read
and approved the final manuscript.
Funding
No source of funding for the study.
Data Availability
All data generated or analysed during this study are included in this published
article.
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Page 10 of 10
Yan et al. BMC Pediatrics (2023) 23:266
Declarations
Ethics approval and consent to participate
This study was approved by the Ethics Committee of Beijing Children’s
Hospital (Approval number: 2022-E-214-R) and the need for informed consent
was waived. All methods used in this study adhere to the tenets of the
Declaration of Helsinki 1967.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1Department of General Surgery, Beijing Children’s Hospital, Capital
Medical University, National Center for Children’s Health, Beijing
100045, China
2Department of Ultrasound, Beijing Children’s Hospital, Capital Medical
University, National Center for Children’s Health, No. 56 Nanlishi Road,
Xicheng District, Beijing 100045, China
3Department of Surgery, Zhuhai City Maternity and Child Health Hospital,
Zhuhai, Guangdong Province 519001, China
Received: 17 November 2022 / Accepted: 6 April 2023
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