“Surgery First” vs. “Endoscopy First” for Pediatric Choledocholithiasis Presenting at the End of the Week - A CARES Working Group Study
Topic overview
This study compares two management strategies for pediatric common bile duct stones presenting late in the week: endoscopy-first (ERCP then cholecystectomy) versus surgery-first (cholecystectomy with intraoperative exploration). The research examines whether limited weekend ERCP availability makes upfront surgical management more efficient in reducing hospital stay and time to treatment.
Key takeaways
- Surgery-first approach (LC with IOC ± LCBDE) may reduce hospital length of stay when ERCP availability is limited at end of week.
- Endoscopy-first strategy remains standard but faces logistical constraints with weekend ERCP scheduling in pediatric choledocholithiasis.
- Intraoperative cholangiogram with transcystic common bile duct exploration offers alternative to staged ERCP-then-cholecystectomy approach.
- Time to definitive intervention is a key metric when comparing single-stage vs. two-stage management of pediatric bile duct stones.
- Weekend presentation timing significantly impacts treatment pathway selection for pediatric choledocholithiasis management.
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How to cite: GlobalCastMD. “Surgery First” vs. “Endoscopy First” for Pediatric Choledocholithiasis Presenting at the End of the Week - A CARES Working Group Study. GlobalCastMD Medical Library. 2024-09-23. https://dev.library.globalcastmd.com/article/9194?via_space=staycurrentmd
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