{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:37:27Z","timestamp":1787585847218,"version":"build-2736575974"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"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>Background<\/jats:title><jats:p>Choledochal cyst (CC) is a common biliary malformation in children and is often associated with severe cholangitis. While endoscopic biliary drainage (EBD) is well established in adults, its efficacy and safety in children remain unclear. This study aimed to compare the effectiveness and safety of EBD with conventional external drainage (CED) in children with CC complicated by severe cholangitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical data from children with CC complicated by severe cholangitis who were treated at Wuhan Children's Hospital between January 1, 2013, and January 31, 2025, were retrospectively analyzed. Patients were divided into CED and EBD groups based on the drainage method. Various clinical outcomes were compared between the two groups, including operative time, intraoperative bleeding, postoperative hospitalization duration, pain scores, complication rates, time to radical surgery, conversion to open surgery, and laboratory indices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty-nine children (CED: <jats:italic>n<\/jats:italic>\u2009=\u200931; EBD: <jats:italic>n<\/jats:italic>\u2009=\u200928) were included (12 males and 47 females, with a mean age of 3.21\u2009\u00b1\u20092.17 years). Compared with CED, the EBD group demonstrated significantly better outcomes, including a shorter operative time (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001), less blood loss (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001), reduced length of stay (3.2 vs. 6.5 days, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001), lower pain scores (2.1 vs. 5.8, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001), fewer complications (3.57% vs. 25.81%, <jats:italic>P<\/jats:italic>\u2009=\u20090.044), shorter radical surgery interval (14 vs. 28 days, <jats:italic>P<\/jats:italic>\u2009=\u20090.002), and lower laparotomy conversion rate (3.57% vs. 29.03%, <jats:italic>P<\/jats:italic>\u2009=\u20090.024). Both groups demonstrated statistically significant differences in postoperative 24\u2005h reductions of total bilirubin and transaminase levels (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In children with CC complicated by severe cholangitis, EBD provides significant advantages over CED. It is less invasive, which leads to faster recovery times and lower complication rates, making it the preferred transitional treatment before definitive surgery.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1648834","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T04:22:44Z","timestamp":1759983764000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Endoscopic biliary drainage outperforms conventional external drainage in pediatric choledochal cyst with severe cholangitis: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Hongxi","family":"Guo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongqiang","family":"Bian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hu","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xufei","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/jhbp.415","article-title":"Japanese clinical practice guidelines for congenital biliary dilatation","volume":"24","author":"Ishibashi","year":"2017","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B2","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.jpedsurg.2018.10.077","article-title":"Development of pediatric minimally invasive surgery in mainland China","volume":"54","author":"Diao","year":"2019","journal-title":"J Pediatr Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1002\/jhbp.691","article-title":"Classification of pancreaticobiliary maljunction and its clinical features in adults","volume":"26","author":"Yoshimoto","year":"2019","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B4","first-page":"434","article-title":"Choledochal cysts: part 1 of 3: classification and pathogenesis","volume":"52","author":"Singham","year":"2009","journal-title":"Can J Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1111\/ans.13981","article-title":"Acute cholangitis: current concepts","volume":"87","author":"Lan Cheong Wah","year":"2017","journal-title":"ANZ J Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1007\/s00383-018-4321-6","article-title":"Clinical features and risk factors of bile duct perforation associated with pediatric congenital biliary dilatation","volume":"34","author":"Fukuzawa","year":"2018","journal-title":"Pediatr Surg Int"},{"key":"B7","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1159\/000268109","article-title":"Management of congenital bile duct cysts","volume":"27","author":"Mabrut","year":"2010","journal-title":"Dig Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1007\/s00534-012-0519-5","article-title":"Endoscopic biliary drainage for children with persistent or exacerbated symptoms of choledochal cysts","volume":"20","author":"Tsuchiya","year":"2013","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B9","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":"B10","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.gie.2014.09.046","article-title":"Endoscopic nasogallbladder tube or stent placement in acute cholecystitis: a preliminary prospective randomized trial in Japan (with videos)","volume":"81","author":"Itoi","year":"2015","journal-title":"Gastrointest Endosc"},{"key":"B11","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1097\/MPG.0000000000000124","article-title":"ERCP Can be safely and effectively performed by a pediatric gastroenterologist for choledocholithiasis in a pediatric facility","volume":"57","author":"Troendle","year":"2013","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B12","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1097\/MPG.0000000000000399","article-title":"Role of pediatric endoscopic retrograde cholangiopancreatography in an era stressing less-invasive imaging modalities","volume":"59","author":"Saito","year":"2014","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1046\/j.1440-1746.2001.02545.x","article-title":"Endoscopic retrograde cholangiopancreatography in the management of pancreaticobiliary disorders in children","volume":"16","author":"Poddar","year":"2001","journal-title":"J Gastroenterol Hepatol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"3611","DOI":"10.1007\/s10620-013-2857-9","article-title":"The safety and efficacy of therapeutic ERCP in the pediatric population performed by adult gastroenterologists","volume":"58","author":"Halvorson","year":"2013","journal-title":"Dig Dis Sci"},{"key":"B15","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":"B16","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1007\/s00383-018-4296-3","article-title":"Endoscopic biliary drainage management for children with serious cholangitis caused by congenital biliary dilatation","volume":"34","author":"Sun","year":"2018","journal-title":"Pediatr Surg Int"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1016\/j.gie.2022.08.025","article-title":"Technological imbalance: seeking a small-caliber duodenoscope","volume":"96","author":"Lin","year":"2022","journal-title":"Gastrointest Endosc"},{"key":"B18","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1007\/s00534-012-0561-3","article-title":"TG13 Guidelines for diagnosis and severity grading of acute cholangitis (with videos)","volume":"20","author":"Kiriyama","year":"2013","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"B19","first-page":"293","article-title":"The FLACC: a behavioral scale for scoring postoperative pain in young children","volume":"23","author":"Merkel","year":"1997","journal-title":"Pediatr Nurs"},{"key":"B20","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/0002-9610(77)90359-2","article-title":"Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst","volume":"134","author":"Todani","year":"1977","journal-title":"Am J Surg"},{"key":"B21","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":"B22","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"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1491579","DOI":"10.3389\/fped.2025.1491579","article-title":"Pediatric endoscopic retrograde pancreatography expertise in chronic pancreatitis: a single-center analysis","volume":"13","author":"Guo","year":"2025","journal-title":"Front Pediatr"},{"key":"B24","doi-asserted-by":"publisher","first-page":"eado1449","DOI":"10.1126\/scitranslmed.ado1449","article-title":"Where do the pathogens that cause surgical site infections come from?","volume":"16","author":"Gilbert","year":"2024","journal-title":"Sci Transl Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/S0140-6736(13)61687-6","article-title":"Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis","volume":"383","author":"Ten Broek","year":"2014","journal-title":"Lancet"},{"key":"B26","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":"B27","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1002\/bjs.8906","article-title":"External biliary drainage and liver regeneration after major hepatectomy","volume":"99","author":"Otao","year":"2012","journal-title":"Br J Surg"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1648834\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T04:22:45Z","timestamp":1759983765000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1648834\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":27,"alternative-id":["10.3389\/fped.2025.1648834"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1648834","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]},"article-number":"1648834"}}