“Surgery First” vs. “Endoscopy First” for Pediatric Choledocholithiasis Presenting at the End of the Week - A CARES Working Group Study

jpedsurg.org

Choledocholithiasis in children is commonly managed with an “endoscopy-first” (EF) strategy (endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC)). Because ERCP availability is often limited at the end of the week (EoW), we hypothesized that a “surgery-first” (SF) approach (LC with intraoperative cholangiogram (IOC) ± transcystic laparoscopic common bile exploration (LCBDE)) would decrease length of stay (LOS) and time to definitive intervention (TTDI).

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Article · Sep 2024 · 1 min read

In brief

This study compares two management strategies for pediatric common bile duct stones presenting late in the week: endoscopy-first (ERCP then cholecystectomy) versus surgery-first (cholecystectomy with intraoperative exploration). The research examines whether limited weekend ERCP availability makes upfront surgical management more efficient in reducing hospital stay and time to treatment.

Surgery-first approach (LC with IOC ± LCBDE) may reduce hospital length of stay when ERCP availability is limited at end of week.
Endoscopy-first strategy remains standard but faces logistical constraints with weekend ERCP scheduling in pediatric choledocholithiasis.
Intraoperative cholangiogram with transcystic common bile duct exploration offers alternative to staged ERCP-then-cholecystectomy approach.
Time to definitive intervention is a key metric when comparing single-stage vs. two-stage management of pediatric bile duct stones.
Weekend presentation timing significantly impacts treatment pathway selection for pediatric choledocholithiasis management.

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