Wake Forest School of Medicine, Winston Salem, USA.
Children's Healthcare of Atlanta, Atlanta, USA.
J Pediatr Surg. 2024 Dec;59(12):161668. doi: 10.1016/j.jpedsurg.2024.08.008. Epub 2024 Aug 8.
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 < 0.05). US was more commonly employed and the number of US and CT scans was similar. The SF group had lower MRCP utilization than EF (29% vs. 59%; p < 0.05). EF patients that received an MRCP had the longest LOS (4.0 d [2.4, 6.3]) compared to SF that did not (1.9 d [1.2, 3.2]) (p < 0.05).
Children with choledocholithiasis managed with an EF approach receive more diagnostic imaging, especially MRCP. While MRCP remains a powerful diagnostic tool, a surgery-first approach can minimize the resource utilization and LOS associated with magnetic resonance imaging.
Level III.
儿童胆石症的发病率正在上升，通常采用内镜优先（EF）的方法进行治疗，该方法首先进行内镜逆行胰胆管造影（ERCP），然后进行腹腔镜胆囊切除术（LC）。磁共振胰胆管成像（MRCP）是一种资源密集型的方式，通常在 ERCP 之前进行，以在干预之前进一步确定是否存在胆总管结石。MRCP 可能导致住院时间（LOS）延长和医疗资源紧张。我们假设采用手术优先（SF）的方法可以减少 MRCP 的使用。
胆石症研究、教育和手术联盟（CARES）工作组对疑似胆石症的儿科患者进行了这项回顾性研究。SF 患者接受 LC+术中胆管造影（IOC）±腹腔镜胆总管探查术（LCBDE）。影像学检查包括超声（US）、MRCP 和计算机断层扫描（CT）。
从 7 家机构中确定了 357 名儿科患者。SF（n=220）组接受的影像学检查少于 EF（n=137）组（1.29 比 1.62；p<0.05）。更常使用 US，US 和 CT 扫描的数量相似。SF 组的 MRCP 使用率低于 EF 组（29%比 59%；p<0.05）。接受 MRCP 的 EF 患者的 LOS 最长（4.0 天[2.4，6.3]），而未接受 MRCP 的 SF 患者的 LOS 最短（1.9 天[1.2，3.2]）（p<0.05）。
采用 EF 方法治疗的胆石症儿童接受了更多的诊断性影像学检查，尤其是 MRCP。虽然 MRCP 仍然是一种强大的诊断工具，但采用手术优先的方法可以最小化与磁共振成像相关的资源利用和 LOS。
III 级。
