Reducing MRCP Utilization Through a “Surgery First” Approach for Pediatric Choledocholithiasis: A CARES Working Group Retrospective Study

Choledocholithiasis in children is rising and frequently managed with an endoscopy-first (EF) approach that utilizes endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). Magnetic resonance cholangiopancreatography (MRCP) is a resource intensive modalit...

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Bibliographic Details
Published in:Journal of pediatric surgery 2024-12, Vol.59 (12), p.161668, Article 161668
Main Authors: Rauh, Jessica L., Dantes, Goeto, Alemayehu, Hanna, Wallace, Marshall, Zamora, Irving J., Callier, Kylie, Slater, Bethany J., Krinock, Derek, Siddiqui, Sabina, Witte, Amanda, Flynn-O-Brien, Katherine, Patwardhan, Utsav M., Ignacio, Romeo, Gomez, Micaela K., Neff, Lucas P., Santore, Matthew T., Vandewalle, Robert, Knod, Jennifer Leslie, Dukleska, Katerina, Livingston, Michael H., Scholz, Stefan, Bosley, Maggie
Format: Article
Language:English
Subjects:
Adolescent
Child
Child, Preschool
Cholangiopancreatography, Endoscopic Retrograde - statistics & numerical data
Cholangiopancreatography, Magnetic Resonance
Cholecystectomy, Laparoscopic - statistics & numerical data
Choledocholithiasis
Choledocholithiasis - diagnostic imaging
Choledocholithiasis - surgery
Female
Humans
Length of Stay - statistics & numerical data
Male
MRCP
Pediatric
Retrospective Studies
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Summary:Choledocholithiasis in children is rising and frequently managed with an endoscopy-first (EF) approach that utilizes endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). Magnetic resonance cholangiopancreatography (MRCP) is a resource intensive modality that often precedes ERCP to gain further assurance of choledocholithiasis prior to intervention. MRCP can lead to a longer length of stay (LOS) and strain healthcare resources. We hypothesized that the use of MRCP is decreased with a surgery-first (SF) approach. The Choledocholithiasis Alliance for Research, Education, and Surgery (CARES) Working Group conducted this retrospective study on pediatric patients with suspected choledocholithiasis. SF patients underwent LC + intraoperative cholangiogram (IOC) ± laparoscopic common bile duct exploration (LCBDE). Imaging studies included ultrasound (US), MRCP, and computed tomography (CT). From seven institutions, 357 pediatric patients were identified. The SF (n = 220) group received fewer imaging studies then EF (n = 137) (1.29 vs. 1.62; p 
ISSN:0022-3468
1531-5037
1531-5037
DOI:10.1016/j.jpedsurg.2024.08.008