Reducing MRCP Utilization Through a "Surgery First" Approach for Pediatric Choledocholithiasis: A CARES Working Group...

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Diagnostic Imaging

Background:

• Choledocholithiasis (bile duct stones) in children is increasing.
• The endoscopy-first (EF) approach uses ERCP and LC, often preceded by MRCP.
• MRCP is resource-intensive and can prolong hospital stays.

Purpose of the Study:

• To evaluate if a surgery-first (SF) approach decreases MRCP utilization in pediatric choledocholithiasis.
• To compare resource utilization between SF and EF management strategies.

Main Methods:

• Retrospective study of pediatric patients with suspected choledocholithiasis.
• SF group: Laparoscopic cholecystectomy (LC) with intraoperative cholangiogram (IOC) +/- laparoscopic common bile duct exploration (LCBDE).
• EF group: Endoscopic retrograde cholangiopancreatography (ERCP) followed by LC. Imaging included US, MRCP, CT.

Main Results:

• SF group (n=220) had fewer imaging studies than EF group (n=137).
• MRCP utilization was significantly lower in the SF group (29%) vs. EF group (59%).
• EF patients receiving MRCP had longer LOS (4.0 days) compared to SF patients without MRCP (1.9 days).

Conclusions:

• The endoscopy-first approach for pediatric choledocholithiasis leads to increased diagnostic imaging, particularly MRCP.
• A surgery-first approach can reduce MRCP use, healthcare resource strain, and length of stay.