{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:37:50Z","timestamp":1787585870835,"version":"build-2736575974"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Currently, there is no established guideline for the application of ERCP in children with choledochal cyst. This study aimed to investigate the safety and effectiveness of ERCP in managing preoperative complications of choledochal cyst in children, as well as the timing for definitive surgery following ERCP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective review of medical records for 68 pediatric patients who presented with complications of choledochal cyst, including pancreatitis and biliary obstruction combined with cholangitis. All patients underwent ERCP treatment followed by definitive surgery. The primary outcomes assessed included treatment efficacy, post-ERCP complication, and the impact of ERCP on definitive surgical procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 68 patients studied, 41 presented with pancreatitis, while the remaining patients had biliary obstruction and cholangitis. Sixty-five patients successfully completed their treatments, with 64 experiencing alleviation of symptoms. Significant improvements were observed in serum amylase levels and liver function tests following ERCP. Post-ERCP complications occurred in three cases, including one case of pancreatitis and two cases of infection. The median interval between ERCP and surgery was 11 days. There was no significant difference in primary outcomes, such as surgical duration, rate of minimally invasive surgery, conversion to open surgery, intraoperative bleeding volume, intraoperative blood transfusion, postoperative complications, or average length of hospital stay, between the early surgery group (\u22642 weeks) and the late surgery group (&amp;gt;2 weeks).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ERCP was proved to be a safe and effective intervention for alleviating preoperative complications in pediatric patients with choledochal cyst. Early definitive surgery following ERCP did not significantly impact the perioperative outcomes of pediatric patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1523753","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T07:14:13Z","timestamp":1737702853000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["The effectiveness of ERCP in managing preoperative complications of choledochal cysts in children and its role in facilitating early surgical intervention"],"prefix":"10.3389","volume":"13","author":[{"given":"Tian","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjie","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijun","family":"Shu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Weng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingzhe","family":"Weng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefeng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1007\/s00383-017-4083-6","article-title":"Pediatric choledochal cysts: diagnosis and current management","volume":"33","author":"Soares","year":"2017","journal-title":"Pediatr Surg Int"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1539","DOI":"10.6061\/clinics\/2020\/e1539","article-title":"Choledochal cysts in children: how to diagnose and operate on","volume":"75","author":"Tannuri","year":"2020","journal-title":"Clinics (Sao Paulo)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1002\/jhbp.485","article-title":"Classification of pancreaticobiliary maljunction and clinical features in children","volume":"24","author":"Urushihara","year":"2017","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s00383-023-05582-z","article-title":"Premalignant\/malignant histology in excised choledochal cyst specimens from children. Experience and literature review","volume":"40","author":"Okazaki","year":"2024","journal-title":"Pediatr Surg Int"},{"key":"B5","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1186\/s12887-023-03994-3","article-title":"Management of complicated choledochal cyst in children: ultrasound-guided percutaneous external drainage and subsequent definitive operation","volume":"23","author":"Yan","year":"2023","journal-title":"BMC Pediatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1159\/000111821","article-title":"Management of complicated choledochal cysts","volume":"24","author":"Lal","year":"2007","journal-title":"Dig Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1089\/lap.2020.0222","article-title":"Comparison and selection of three methods of minimally invasive external drainage for children with congenital choledochal cysts","volume":"31","author":"Song","year":"2021","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1111\/ans.15674","article-title":"Usefulness of pre-operative endoscopic retrograde cholangiopancreatography in diagnosis and management of forme fruste choledochal cyst in children","volume":"90","author":"Wang","year":"2020","journal-title":"ANZ J Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0210805","DOI":"10.1371\/journal.pone.0210805","article-title":"ERCP in infants, children, and adolescents-different roles of the methods in different age groups","volume":"14","author":"Keil","year":"2019","journal-title":"PLoS One"},{"key":"B10","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/S0016-5107(04)01721-3","article-title":"Technical outcomes and complications of ERCP in children","volume":"60","author":"Varadarajulu","year":"2004","journal-title":"Gastrointest Endosc"},{"key":"B11","doi-asserted-by":"publisher","first-page":"775378","DOI":"10.3389\/fped.2022.775378","article-title":"Retrospective analysis of the accuracy of high-frequency ultrasound for pancreaticobiliary maljunction in pediatrics at a single center","volume":"10","author":"Xu","year":"2022","journal-title":"Front Pediatr"},{"key":"B12","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1097\/RUQ.0000000000000585","article-title":"Transabdominal ultrasound evaluation of pancreaticobiliary maljunction in children","volume":"38","author":"Ma","year":"2022","journal-title":"Ultrasound Q"},{"key":"B13","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1016\/j.gie.2024.05.016","article-title":"American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of chronic pancreatitis: summary and recommendations","volume":"100","author":"Sheth","year":"2024","journal-title":"Gastrointest Endosc"},{"key":"B14","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1055\/s-0042-111002","article-title":"Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guideline executive summary","volume":"49","author":"Tringali","year":"2017","journal-title":"Endoscopy"},{"key":"B15","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1111\/1751-2980.13152","article-title":"Clinical characteristics and endoscopic treatment of pancreatitis caused by pancreaticobiliary malformation in Chinese children","volume":"23","author":"Zhang","year":"2022","journal-title":"J Dig Dis"},{"key":"B16","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1007\/s00595-022-02571-y","article-title":"Using machine learning models to predict acute pancreatitis in children with pancreaticobiliary maljunction","volume":"53","author":"Han","year":"2023","journal-title":"Surg Today"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1897","DOI":"10.1016\/j.jpedsurg.2012.12.038","article-title":"Pancreatic complications in pediatric choledochal cysts","volume":"48","author":"Fujishiro","year":"2013","journal-title":"J Pediatr Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1002\/jpn3.12138","article-title":"An observational study on the prevalence of choledochal cyst with pancreatitis: geographical implications and management","volume":"78","author":"Hegde","year":"2024","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B19","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1016\/j.jpedsurg.2022.12.024","article-title":"Outcomes of laparoscopic versus open resection of pediatric choledochal cyst","volume":"58","author":"Ramsey","year":"2023","journal-title":"J Pediatr Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1007\/s00423-023-02952-y","article-title":"An audit of complicated choledochal cysts- 15-years\u2019 experience at a tertiary care center","volume":"408","author":"Pakkala","year":"2023","journal-title":"Langenbeck\u2019s Arch Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"10606","DOI":"10.3748\/wjg.v20.i30.10606","article-title":"Coagulopathy in a subtype of choledochal cyst and management strategy","volume":"20","author":"Diao","year":"2014","journal-title":"World J Gastroenterol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/s40792-015-0115-4","article-title":"Endoscopic biliary drainage as a bridging procedure to single-stage surgery for perforated choledochal cyst: a case report and review of the literature","volume":"1","author":"Minagawa","year":"2015","journal-title":"Surg Case Rep"},{"key":"B23","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.diii.2017.05.010","article-title":"Percutaneous management of benign biliary disorders in children","volume":"99","author":"Kahriman","year":"2018","journal-title":"Diagn Interv Imaging"},{"key":"B24","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1177\/1457496918822617","article-title":"Increased prevalence of pancreaticobiliary maljunction in biliary malignancies","volume":"108","author":"Hyv\u00e4rinen","year":"2019","journal-title":"Scand J Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"6107","DOI":"10.3748\/wjg.v25.i40.6107","article-title":"Endoscopic retrograde cholangiopancreatography in children with symptomatic pancreaticobiliary maljunction: a retrospective multicenter study","volume":"25","author":"Zeng","year":"2019","journal-title":"World J Gastroenterol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1016\/j.jpedsurg.2023.11.026","article-title":"Efficacy and safety of endoscopic retrograde cholangiopancreatography in children of pancreaticobiliary maljunction without obvious biliary dilatation","volume":"59","author":"Qian","year":"2024","journal-title":"J Pediatr Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"712","DOI":"10.4240\/wjgs.v15.i4.712","article-title":"External use of mirabilite to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis in children: a multicenter randomized controlled trial","volume":"15","author":"Zeng","year":"2023","journal-title":"World J Gastrointest Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e247","DOI":"10.1097\/MPA.0000000000002296","article-title":"Risk factors for post-endoscopic retrograde cholangio-pancreatography pancreatitis in children with chronic pancreatitis and its prediction using 4-hour postprocedure serum amylase and lipase levels","volume":"53","author":"Samanta","year":"2024","journal-title":"Pancreas"},{"key":"B29","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1097\/MPG.0000000000003766","article-title":"Risk factors for post-ERCP pancreatitis in pediatric and young adult patients","volume":"76","author":"Hassan","year":"2023","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B30","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1055\/s-0043-107776","article-title":"Endoscopic sphincterotomy in pediatric patients: do we know enough?","volume":"49","author":"Agarwal","year":"2017","journal-title":"Endoscopy"},{"key":"B31","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1007\/s12328-024-01960-9","article-title":"Minimal endoscopic sphincterotomy followed by papillary balloon dilation to relieve choledocholithiasis in a 6-year-old girl with hereditary spherocytosis","volume":"17","author":"Yabe","year":"2024","journal-title":"Clin J Gastroenterol"},{"key":"B32","first-page":"e239","article-title":"Management of choledochal cyst with portal hypertension","volume":"52","author":"Saluja","year":"2011","journal-title":"Singapore Med J"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1523753\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T07:14:15Z","timestamp":1737702855000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1523753\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,24]]},"references-count":32,"alternative-id":["10.3389\/fped.2025.1523753"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1523753","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,24]]},"article-number":"1523753"}}