# Efficacy of Endoscopic Retrograde Cholangiopancreatography and Frey Procedure in the Treatment of Pediatric Pancreatic Duct Stones: A Single-Center Retrospective Cohort Study

## TL;DR

This study compares two treatments for pancreatic duct stones in children and finds that the Frey procedure has better long-term results than ERCP.

## Contribution

A direct comparison of ERCP and Frey procedure efficacy in pediatric pancreatic duct stones using a single-center retrospective cohort.

## Key findings

- The Frey procedure had a significantly lower stone recurrence rate and fewer reinterventions compared to ERCP.
- The 5-year intervention-free survival rate was higher in the Frey group (88.86%) than in the ERCP group (57.75%).

## Abstract

Objective: To compare the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and the Frey procedure in the treatment of pediatric pancreatic duct stones (PDS). Methods: A retrospective analysis was conducted on 65 pediatric patients treated for pancreatic duct stones in the Department of Pediatric Surgery, West China Hospital of Sichuan University, between February 2018 and May 2025. Demographic data, perioperative clinical parameters, postoperative recovery, and complications were collected. The efficacy and complications of ERCP and the Frey procedure were evaluated. Results: Of the 65 patients, 37 (56.92%) were male and 28 (43.08%) were female, with a median surgical age of 14 (11, 16) years. 32 patients (49.23%) underwent ERCP, and 33 patients (50.77%) underwent the Frey procedure. Significant differences were observed between the two groups in the degree of main pancreatic duct dilation (6.45 vs. 9.11, p < 0.001), postoperative stone recurrence (13 vs. 3, p = 0.003), and number of reinterventions (3.98 vs. 1.27, p < 0.001). The 5-year intervention-free survival rate was 57.75% in the ERCP group and 88.86% in the Frey group, with a statistically significant difference between groups (p = 0.024). Conclusions: Both ERCP and the Frey procedure are effective for pediatric PDS. ERCP is preferred for patients with mild ductal dilation and first-onset stones. However, for those with significant ductal dilation or recurrent stones with suboptimal ERCP outcomes, the Frey procedure is recommended.