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Efficacy of ERCP via the accessory papilla in children with choledochal cysts
Katsunori Kouchi1, Hideo Yoshida, Tadashi Matsunaga
1Department of Pediatric Surgery, School of Medicine, Chiba University, Chiba, Japan.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) via the accessory papilla effectively visualizes pancreatic and biliary ducts in children with choledochal cysts when standard ERCP is unsuccessful. This method aids in diagnosing ductal abnormalities.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Surgical Anatomy
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) via the major duodenal papilla may fail to visualize the pancreatic duct in children with choledochal cysts.
- Dilated common bile ducts can obstruct the pancreatic duct, hindering visualization.
Purpose of the Study:
- To evaluate the efficacy of ERCP via the accessory papilla in children with choledochal cysts.
- To determine if accessory papilla ERCP can overcome visualization limitations of major papilla ERCP.
Main Methods:
- Patients with choledochal cysts were grouped based on pancreatic and biliary duct visualization via major duodenal papilla ERCP.
- ERCP via the accessory papilla was performed in patients with incomplete visualization.
- 0.6- or 0.8-mm metal-tip catheters were used for accessory papilla ERCP.
Main Results:
- ERCP via the accessory papilla was successful in 5 out of 6 patients in the incomplete visualization group.
- Diagnoses included pancreas divisum, protein plug, and detailed visualization of ductal junctions.
- No pancreatitis complications occurred following ERCP, including accessory papilla procedures.
Conclusions:
- ERCP via the accessory papilla is an effective alternative for visualizing the pancreatic ductal system and biliopancreatic junction in children with choledochal cysts.
- This technique is valuable when standard ERCP via the major duodenal papilla is insufficient.
Background:
ERCP via the major duodenal papilla in children with choledochal cyst may not clearly visualize the entire pancreatic duct and the junction of the pancreatic and biliary ducts. This may be caused by obstruction of the pancreatic duct by a dilated common bile duct.
Methods:
Patients with choledochal cysts who underwent ERCP with injection of contrast medium at the major duodenal papilla were classified as either belonging to a MP group, in which the entire pancreatic duct and junction of the pancreatic and biliary ducts were visualized, or to a M/AP group, in which these structures were either partially visualized or not visualized. ERCP via the accessory papilla subsequently was performed in the M/AP group by using 0.6- or 0.8-mm metal-tip catheters. The efficacy of ERCP via the accessory papilla in children with choledochal cysts was evaluated.
Observations:
ERCP was performed in 13 patients. Seven were assigned to the MP group and 6 to the M/AP group. ERCP via the accessory papilla in the M/AP group was successful in 5 of the 6 patients; pancreas divisum was demonstrated in one, a protein plug at the main pancreatic duct in another, and the entire pancreatic duct and junction of the pancreatic and biliary ducts in the remaining 3 patients. No patient developed pancreatitis as a result of ERCP, including ERCP via the accessory papilla.
Conclusions:
In children with choledochal cyst, ERCP via the accessory papilla is an effective method for visualization of the detailed structure of the entire pancreatic ductal system and junction of the pancreatic and biliary ducts when ERCP via the major duodenal papilla is unsuccessful.
