Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Children as young as 12-13 years old present with acute pancreatitis and acute recurrent pancreatitis from PRSS1 mutation — Juan Gurria, Pediatric pancreatitis: diagnosis, causes, and genetic insights with Dr. Juan Gurria · 2:23
Pediatric pancreatitis: diagnosis, causes, and genetic insights with Dr. Juan Gurria
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Dr. Juan Gurria from Cincinnati Children's discusses pancreatitis in children, detailing diagnostic criteria including clinical symptoms, elevated serum lipase, and imaging like MRI with MRCP. He emphasizes that pediatric pancreatitis has d
podcast3:12 · Nov 2026
Early drainage comes with a lot of morbidity unless the patient is progressing to multi-organ failure — Juan Gurria, Acute pancreatitis in children: early feeding and step-up surgical approach · 1:21
Acute pancreatitis in children: early feeding and step-up surgical approach
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This video, featuring Dr. Juan Gurria from Cincinnati Children's, discusses the acute management of pancreatitis in children. It covers critical aspects like early enteral nutrition to maintain gut integrity, the appropriate use of intraven
podcast3:03 · Nov 2026
According to the Atlanta classification, acute problems occur in fluid collections less than 4 weeks old. — Juan Gurria, Managing pancreatic fluid collections and chronic pancreatitis complications in children · 0:50
Surgical Management1 item
Surgical management of chronic pancreatitis in children: when and how to intervene
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This video, featuring Dr. Juan Gurria from Cincinnati Children's, discusses surgical interventions for chronic pancreatitis in children. It covers indications for surgery, various treatment options like drainage and resection, and the compl
podcast4:05 · Nov 2026
Complications1 item
Managing pancreatic fluid collections and chronic pancreatitis complications in children
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This video, featuring Dr. Juan Gurria from Cincinnati Children's, discusses the complications of pancreatitis in children, focusing on pancreatic fluid collections and the transition to chronic pancreatitis. It explains the Atlanta classifi
podcast2:28 · Nov 2026
The choice between surgery-first and ERCP-first depends on the setting and the surgeon's own technical capabilities. Surgery-first approach for pediatric biliary stones and common bile duct management · 1:50
Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024
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Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024 | Podcast Episode on RSS.com Sign up free Features Resources Pricing Podcasts Sign up free Sign In Stay Current in Pediatric Surgery... Update Course Re
podcast3:53 · Jul 2026
Surgery-first approach for pediatric biliary stones and common bile duct management
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Welcome to the 12th Annual Update Course in Pediatric Surgery recap series, hosted by Dr. Em Gootee from Cincinnati Children’s Hospital. In this Green Circle (established practice) session, Drs. David Vitale, Luke Neff, and Jeff Ponsky expl
podcast7:32 · Nov 2026
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Gallstone pancreatitis results from biliary obstruction that impedes pancreatic drainage, causing enzyme accumulation and pancreatic injury. Management hinges on biochemical trajectory: rising amylase/lipase after initial presentation suggests impacted stone requiring ERCP, while declining levels indicate spontaneous passage and readiness for cholecystectomy. Early ERCP is reserved for persistent obstruction or cholangitis rather than routine use. Timing of cholecystectomy remains debated—some operate within days, others wait a week—but consensus favors proceeding when symptoms improve regardless of complete biochemical normalization, coordinating intraoperative cholangiogram with ERCP availability. Most stones clear or pass spontaneously, demanding clinical judgment tailored to local resources. Special populations require nuanced approaches: neutropenic/thrombocytopenic patients may respond to conservative antibiotic management with spontaneous stone passage, deferring surgery until hematologic recovery.
- Declining amylase/lipase signals stone passage; rising levels 24 hours post-presentation mandate ERCP for likely impacted stone.
- Early ERCP is indicated only for persistent obstruction or cholangitis, not routine gallstone pancreatitis.
- Cholecystectomy timing varies (days to week) but should proceed with clinical improvement, not biochemical normalization.
- Neutropenic/thrombocytopenic patients may benefit from conservative management allowing spontaneous passage before elective surgery.
- Most biliary stones clear spontaneously; management must integrate clinical judgment with local ERCP and surgical resources.
For patients & families
Pediatric pancreatitis is inflammation of the pancreas, an organ that helps with digestion. One common cause in children is gallstone pancreatitis, which happens when a small stone from the gallbladder blocks the bile duct and prevents digestive enzymes from leaving the pancreas, causing them to build up and damage the organ . Doctors monitor blood tests called amylase and lipase to track the inflammation. If these levels start going down after the child arrives at the hospital, it usually means the stone has passed on its own and surgery to remove the gallbladder can proceed . However, if the levels keep rising a day later, doctors may need to perform a procedure called ERCP to remove the stuck stone . Many stones do pass without intervention, and physicians use their judgment along with what resources are available at their hospital to decide the best approach . For surgery timing, doctors typically wait until symptoms are improving rather than waiting for all blood tests to return completely to normal . In complex cases, such as children with weakened immune systems, antibiotics and careful monitoring may allow the stone to pass naturally before surgery .
Pediatric pancreatitis is inflammation of the pancreas, an organ that helps with digestion. One common cause in children is gallstone pancreatitis, which happens when a small stone from the gallbladder blocks the bile duct and prevents digestive enzymes from leaving the pancreas, causing them to build up and damage the organ . Doctors monitor blood tests called amylase and lipase to track the inflammation. If these levels start going down after the child arrives at the hospital, it usually means the stone has passed on its own and surgery to remove the gallbladder can proceed . However, if the levels keep rising a day later, doctors may need to perform a procedure called ERCP to remove the stuck stone . Many stones do pass without intervention, and physicians use their judgment along with what resources are available at their hospital to decide the best approach . For surgery timing, doctors typically wait until symptoms are improving rather than waiting for all blood tests to return completely to normal . In complex cases, such as children with weakened immune systems, antibiotics and careful monitoring may allow the stone to pass naturally before surgery .
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Surgery-first approach for pediatric biliary stones and common bile duct management
Stone disease is increasing along with obesity in pediatric patients around the world, not just in the United States.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position0:52 ↗
There are two main approaches for patients with common bile duct stones who need cholecystectomy: ERCP first followed by laparoscopic cholecystectomy, or laparoscopic cholecystectomy with intraoperative cholangiogram to identify and potentially remove stones during the same surgery.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position1:25 ↗
The choice between surgery-first and ERCP-first depends on the setting and the surgeon's own technical capabilities.
opinion1:50 ↗
A surgery-first pathway reduces resource utilization, including MRCP.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position2:11 ↗
A predictive score for cholelithiasis published in the Journal of American College of Surgeons can help guide pathway decisions.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position2:25 ↗
ERCP causes pancreatitis 10% of the time, regardless of operator skill.
clinical3:02 ↗
If a surgeon cannot perform a cholangiogram, then ERCP is necessary if someone can do it.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position3:16 ↗
Pediatric surgeons and general surgeons need to improve their skills in intraoperative stone removal through courses and training.
opinion3:34 ↗
If you understand central line placement and Seldinger technique principles, you can perform intraoperative stone removal.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position3:44 ↗
In a JPS paper, surgery-first approach achieved 86% stone clearance rate with negative intraoperative cholangiogram.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position3:50 ↗
With simple additional maneuvers like advancing the catheter into the common bile duct or reaming the sphincter, stone clearance success rate reaches the 90s.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position4:02 ↗
For the 15% of unsuccessful cases, the surgeon clips or places an endo loop, closes, and arranges ERCP within the next day or two.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position4:17 ↗
At Cincinnati Children's, when surgeons cannot clear the duct, they call the endoscopist to the OR and ERCP is performed quickly in most cases.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position4:38 ↗
According to Doctor Huntington, the biggest key to success is having all necessary equipment in one place, because OR staff will not know what to get on the fly.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position5:15 ↗
If the common bile duct has 3-4 impacted stones on IOC, surgery-first is typically not very successful.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position5:26 ↗
Doctor Vitale cautions that when flushing with an impacted stone, there is risk of inadvertently injecting contrast into the pancreatic duct, which can increase pancreatitis risk.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position6:03 ↗
When the pancreatic duct lights up during flushing, this is a signal to slow down because you can cause pancreatitis by flushing contrast into the pancreatic duct with a stone present.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position6:15 ↗
A study demonstrated 86% success rate for surgery-first, while the ERCP group had 10% complication rate including cholangitis, bleeding, pancreatitis, and hemophilia.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position6:33 ↗
Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024
The 12th annual update course in pediatric surgery introduced a new classification system with three categories: Green Circle for established practice, Blue Square for promising newer practice, and Black Diamond for early adopter practice only.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position0:08 ↗
A 16-year-old male with acute lymphoblastic leukemia (ALL), neutropenic and thrombocytopenic, presented with right upper quadrant pain, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis.
clinicalDavid Vitale0:53 ↗
Over 50% of the live and virtual audience poll opted to start antibiotics and address the elevated liver function tests in the neutropenic thrombocytopenic patient.
opinionDavid Vitale1:18 ↗
Dr. Neff's patient spontaneously passed the stone, LFTs came back down, counts recovered, and the patient proceeded to elective cholecystectomy.
clinicalDavid Vitale1:27 ↗
Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage, preventing pancreatic enzymes from reaching the small intestine and leading them to accumulate and damage the pancreas.
clinicalLuke Neff1:39 ↗
Some surgeons will do cholecystectomy within a few days for gallstone pancreatitis, while others will wait for a week.
opinionLuke Neff2:07 ↗
From an ERCP standpoint, unless there's a persistent biliary obstruction or cholangitis, ERCP is not performed right away for gallstone pancreatitis.
clinicalLuke Neff2:15 ↗
When symptoms are improving in gallstone pancreatitis, cholecystectomy with intraoperative cholangiogram can proceed without waiting for biochemical normalization, coordinating with ERCP availability if needed.
clinicalDavid Vitale2:24 ↗
Studies have shown that if amylase and lipase levels go up when a patient comes in with acute biliary pancreatitis and then start going down, the stone has likely passed and the patient can proceed to cholecystectomy.
clinicalLuke Neff2:38 ↗
If amylase and lipase continue to rise one day after presentation with acute biliary pancreatitis, ERCP should be performed because the stone is likely impacted.
clinicalLuke Neff2:38 ↗
Most biliary stones can be cleared, and some stones pass spontaneously, requiring good clinical judgment.
clinicalDavid Vitale2:59 ↗
Local resources and what is available must be factored into management decisions for biliary stones.
opinionDavid Vitale3:07 ↗
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