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Utility of ERCP in neonatal and infant cholestasis
Lars Aabakken1, Ingegerd Aagenaes, Truls Sanengen
1Department of Medicine, Rikshospitalet University Hospital, Oslo, Norway. larsaa@medisin.uio.no
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) is a safe and feasible diagnostic tool for neonatal cholestasis when other imaging is inconclusive. It aids in diagnosing biliary atresia and other conditions in infants.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Hepatology
Background:
- Neonatal and infant jaundice requires early diagnosis.
- Biliary atresia (BA) and other pancreaticobiliary disorders can be challenging to diagnose noninvasively.
- Endoscopic retrograde cholangiopancreatography (ERCP) is explored for its utility in these cases.
Purpose of the Study:
- To evaluate the feasibility and safety of ERCP in neonates and infants with suspected biliary obstruction.
- To assess ERCP's diagnostic accuracy for conditions like biliary atresia.
- To determine ERCP's role in the workup of inconclusive jaundice cases.
Main Methods:
- 23 ERCP procedures were performed in 22 neonates and infants (mean age 2.4 months, mean weight 4.8 kg).
- A pediatric videoendoscope (7.5 mm outer diameter) was used.
- ERCP was performed when other imaging modalities were inconclusive for biliary obstruction.
Main Results:
- ERCP was successful in 20 out of 23 patients.
- Biliary atresia was correctly suggested in 6 patients, confirmed surgically.
- ERCP provided detailed visualization for treatment planning in choledochal cysts and perforation cases.
Conclusions:
- ERCP is a feasible and safe procedure for diagnosing neonatal cholestasis when other imaging fails.
- ERCP remains valuable in the multidisciplinary approach to diagnosing infant jaundice, even with advanced imaging like MRCP.
Background And Study Aims:
In neonates and infants with biliary obstruction, the diagnosis is important to establish early. Despite the use of several noninvasive imaging modalities, a definite diagnosis of biliary atresia (BA) or other pancreaticobiliary disorders may be difficult to ascertain. In this paper, we report our experience with endoscopic retrograde cholangiopancreaticography (ERCP) in the clinical situation of neonatal and infant jaundice.
Patients And Methods:
Between 1999 and 2006, we performed 23 ERCP procedures in 22 neonates and infants with the provisional diagnosis of biliary obstruction where other imaging was inconclusive. The mean age was 2.4 months and the mean weight was 4.8 kg. A pediatric videoendoscope with an outer diameter of 7.5 mm was used in all patients.
Results:
ERCP was successful in 20 of 23 patients. BA was suggested in 6 patients, all subsequently verified by surgery. Detailed visualization of biliary structures important for planning of treatment was performed in children with choledochal cysts and spontaneous biliary perforation. Cannulation of the ampulla failed in 3 patients, of whom 1 had BA, 1 a choledochal stone, and 1 bile plug syndrome. Only 1 therapeutic ERCP was performed in a child with a stone completely obstructing the ampulla. The only complications were 1 asymptomatic case of hyperamylasemia and 1 of mild cholangitis successfully treated with antibiotics.
Conclusions:
ERCP is feasible and safe in the workup of neonatal cholestasis where other imaging modalities are inconclusive. Despite the expanding role of magnetic resonance cholangiography, ERCP may still have a role in the multidisciplinary workup of these patients.
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