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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.

Seminars in Pediatric Surgery

|September 26, 2025

Summary

This summary is machine-generated.

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.

Keywords:

Choledocholithiasis ERCP Intraoperative Cholangiogram Laparoscopic Common Bile Duct Exploration Pediatric

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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.