J Surg Res. 2025 Nov 22;316:59-64. doi: 10.1016/j.jss.2025.10.028. Online ahead of print.
ABSTRACT
INTRODUCTION: Magnetic resonance cholangiopancreatography (MRCP) is commonly performed for suspected choledocholithiasis to determine the need for subsequent endoscopic retrograde cholangiopancreatography (ERCP), but some studies suggest this diagnostic tool is associated with increased hospital length of stay and cost. We hypothesize that an elevated total bilirubin and ultrasound (US) findings of biliary ductal dilation with cholelithiasis can predict a therapeutic ERCP in pediatric choledocholithiasis.
METHODS: A retrospective chart review was performed at our free-standing children’s hospital of patients with MRCP reports concerning for choledocholithiasis from 2019 to 2024. We collected information on laboratory values, radiologic studies, and subsequent interventions.
RESULTS: There were 110 patients identified over a 5-y period who were admitted with concern for choledocholithiasis. Of those patients, 66 had no endoscopic intervention prior to surgery while 44 patients underwent endoscopic intervention preoperatively. Thirty-eight of the 44 patients had an US and MRCP available for comparison. The patients that underwent ERCP had a significantly higher median total bilirubin on admission (1.94 versus 3.03, P value 0.027). In these patients, US most commonly showed biliary ductal dilation in 38 of 38 patients while MRCP demonstrated concern for choledocholithiasis in 34 of 38 patients. Of the 38 patients with both imaging studies, 24 of 38 (63%) were found to have choledocholithiasis on ERCP.
CONCLUSIONS: When comparing US and MRCP findings of the group undergoing endoscopic intervention, MRCP did not significantly influence the success rate of endoscopic intervention. In the appropriate patient, biliary ductal dilation on US with a total bilirubin ≥3 mg/dL may be a sufficient tool to direct further endoscopic intervention for choledocholithiasis.
PMID:41275533 | DOI:10.1016/j.jss.2025.10.028
