Endoscopic Retrograde Cholangiopancreatography (ERCP) Findings in Pediatric Patients with Choledocholithiasis Justify a Surgery-First Approach: A Multi-Center Study

In brief

This multi-center study challenges the traditional endoscopy-first approach for pediatric choledocholithiasis, proposing that a surgery-first strategy using intraoperative techniques may be safer and more efficient. By utilizing laparoscopic cholecystectomy with intraoperative cholangiogram and bile duct exploration, surgeons can potentially avoid ERCP-related complications while effectively managing bile duct stones in children.

• Traditional endoscopy-first approach with ERCP before cholecystectomy carries risks: pancreatitis, bleeding, infection, and perforation.
• Some choledocholithiasis stones may pass spontaneously, making preoperative ERCP potentially unnecessary in select pediatric cases.
• Surgery-first approach using IOC, LCBDE, power flushing, and glucagon may provide safer, more efficient treatment pathway.
• Intraoperative techniques can address common bile duct stones without exposing patients to pre-surgical ERCP complications.
• Multi-center data supports reconsidering traditional ERCP-first protocol in favor of surgical management as initial strategy.

Written by the GCMD Library team from the article.