Journal of Pediatric Surgery Open · Published 2026-07-29 · DOI 10.1016/j.yjpso.2026.100297
Kunpeng Yang, Chengyang Jiang, Yifeng Shao, Zhaoying Li, Chuanyu Yang, Long Li, Mei Diao
Purpose: To evaluate the clinical value of preoperative therapeutic endoscopic retrograde cholangiopancreatography (ERCP) before definitive surgery in children with choledochal cysts. Methods: This single-center retrospective cohort study included children who underwent complete choledochal cyst excision with Roux-en-Y hepaticojejunostomy between January 2016 and January 2024. Patients were classified into an ERCP group and a direct-surgery group according to whether therapeutic ERCP had been performed at outside hospitals before definitive surgery. Propensity score matching (1:2) was performed using age, sex, intraluminal biliary obstructive material, and history of pancreatitis. Results: The matched cohort included 123 children: 41 in the ERCP group and 82 in the direct-surgery group. All 41 patients in the ERCP group underwent therapeutic or bridging ERCP; no diagnostic-only ERCP was identified. ERCP reduced protein plugs/stones, pancreatitis, abdominal pain, vomiting, jaundice, and fever before definitive surgery. Preoperative ALT, AST, and GGT levels were lower in the ERCP group. However, ERCP did not improve postoperative recovery, short-term complications, or midterm follow-up outcomes. Operative time was longer and total medical cost was higher in the ERCP group. Stent-related adverse events occurred in 3 of 32 stent-treated patients (9.4%). Conclusions: Preoperative therapeutic ERCP may provide short-term symptomatic and biochemical improvement in selected complicated cases, but these benefits did not translate into better perioperative or midterm outcomes. For children with a clear diagnosis and suitable condition for surgery, direct definitive surgery may be a simpler and more economical pathway; ERCP should be reserved as a selective bridging strategy.
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Yang, K., Jiang, C., Shao, Y., et al. (2026). Clinical value of preoperative therapeutic ERCP before definitive surgery in children with choledochal cysts. Journal of Pediatric Surgery Open. https://doi.org/10.1016/j.yjpso.2026.100297