Publication Name	World Journal of Gastrointestinal Surgery
Manuscript ID	111649
Country	Spain

Category	Gastroenterology & Hepatology
Manuscript Type	Editorial
Article Title	Magnetic resonance cholangiopancreatography and laparoscopic bile duct exploration should be standard procedures for patients with the ice-breaking sign?
Manuscript Source	Invited Manuscript
All Author List	Lucia Mejuto, Maria Delgado and Luis R Rabago
Funding Agency and Grant Number
Corresponding Author	Luis R Rabago, MD, PhD, Department of Gastroenterology, San Rafael Hospital, Street Serrano 199, Madrid 28016, Spain. lrabagot@gmail.com
Key Words	Ice breaking sign; Magnetic resonance cholangiopancreatography; Choledocholithiasis; Laparoscopic bile duct exploration; Common bile duct stones treatment; Endoscopic retrograde cholangiopancreatography
Core Tip	The study makes a noteworthy contribution by identifying a novel magnetic resonance cholangiopancreatography radiologic sign, the "ice-breaking sign" (IBS), which may help define a subgroup of patients with common bile duct stones (CBDS) at increased risk for failure of endoscopic treatment. The authors conducted a retrospective case-control study comparing patients exhibiting the IBS with a control group of CBDS patients without this sign. The objective was to evaluate treatment outcomes in both groups following endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE). Despite the novel contribution, several limitations, including group heterogeneity and suboptimal ERCP success rates, weaken the strength of the conclusions. At present, the evidence is insufficient to establish the IBS as a reliable predictor for treatment planning or to support a general recommendation for LCBDE as a first-line therapy.
Citation	Mejuto L, Delgado M, Rabago LR. Magnetic resonance cholangiopancreatography and Laparoscopic bile duct exploration should be standard procedures for patients with the ice-breaking sign? World J Gastrointest Surg 2025; In press

Received	2025-07-06 16:13
Peer-Review Started	2025-07-06 16:13
To Make the First Decision
Return for Revision	2025-07-25 06:40
Revised	2025-07-27 16:09
Second Decision	2025-08-26 02:38
Accepted by Journal Editor-in-Chief
Accepted by Executive Editor-in-Chief	2025-08-26 03:31
Articles in Press	2025-08-26 03:31
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ISSN	1948-9366 (online)
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