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ERCP first vs. Surgery first: A comparative perspective in pediatric choledocholithiasis
Wesley Judy1, Micaela K Gomez2, Quin Liu3
1University of California San Diego, Department of Pediatrics, 9500 Gilman Dr, La Jolla, CA, 92093, USA; Rady Children's Hospital, Division of Gastroenterology, 3020 Children's Way, San Diego, CA, 92123, USA.
Insights
Pediatric choledocholithiasis management involves "endoscopy-first" or "surgery-first" approaches. The surgery-first method shows potential advantages, but standardized algorithms are needed for optimal care.
Area of Science:
- Pediatric Gastroenterology and Surgery
- Hepatobiliary Diseases
Background:
- Pediatric choledocholithiasis is uncommon but increasingly diagnosed.
- Current management relies on either an "endoscopy-first" or "surgery-first" strategy.
Purpose of the Study:
- To compare the "endoscopy-first" and "surgery-first" approaches for pediatric choledocholithiasis.
- To analyze the clinical outcomes and healthcare resource utilization of each approach.
Main Methods:
- Review of existing literature and clinical practice patterns.
- Point-counterpoint analysis of "endoscopy-first" versus "surgery-first" strategies.
- Discussion of institutional capabilities influencing management decisions.
Main Results:
- The "surgery-first" approach offers potential advantages.
- No standardized treatment algorithm currently exists for pediatric choledocholithiasis.
- Management decisions are heavily influenced by institutional capabilities and clinician practices.
Conclusions:
- Further research is essential to establish evidence-based treatment guidelines.
- A multidisciplinary approach is required to develop consensus-driven algorithms.
- Optimizing pediatric choledocholithiasis management necessitates a standardized approach.
Abstract:
Pediatric choledocholithiasis is a rare but increasingly recognized disease process that is predominantly managed with either an "endoscopy-first" or "surgery-first" approach. In the endoscopy-first approach, a preoperative endoscopic retrograde cholangiopancreatography is performed with subsequent cholecystectomy. In contrast, the surgery-first approach is a single-stage procedure that includes a laparoscopic cholecystectomy and intraoperative cholangiogram, followed by a laparoscopic common bile duct exploration when indicated. Recent studies have highlighted the potential advantages of the SF approach. However, no standardized treatment algorithm exists, and institutional capabilities and practicing patterns heavily influence management decisions. This point-counterpoint review explores both approaches, analyzing their effects on clinical outcomes and healthcare resources. Continued research and a multidisciplinary approach are needed to develop consensus-driven treatment algorithms.
