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

jpedsurg.org

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.

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Article · Aug 2024 · 1 min read

In brief

This retrospective study examines strategies to reduce unnecessary MRCP imaging in pediatric patients with bile duct stones. By comparing surgery-first versus endoscopy-first approaches, the research evaluates how treatment sequencing affects imaging utilization, length of stay, and healthcare resource consumption in children with choledocholithiasis.

Surgery-first approach for pediatric choledocholithiasis reduces MRCP utilization compared to endoscopy-first strategies.
MRCP before ERCP increases length of stay and consumes healthcare resources without always changing management.
Laparoscopic cholecystectomy with intraoperative cholangiography can identify stones without pre-operative MRCP.
Selective imaging protocols may decrease unnecessary advanced imaging in pediatric biliary stone disease.

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