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Conjugated Hyperbilirubinemia in Infants: Is There Still a Role for ERCP?

Jan Stovicek1, Stepan Hlava1, Radan Keil1

  • 1Department of Internal Medicine, Charles University in Prague, 2nd Faculty of Medicine, University Hospital Motol in Prague, Prague, Czech Republic.

Canadian Journal of Gastroenterology & Hepatology
|July 14, 2021
PubMed

Insights

Endoscopic retrograde cholangiopancreatography (ERCP) is safe and effective for infants with suspected biliary obstruction. This study shows ERCP can prevent unnecessary surgeries in infants with biliary atresia or other treatable conditions.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Interventional Endoscopy

Background:

  • Biliary obstruction in infants presents diagnostic and therapeutic challenges.
  • Endoscopic retrograde cholangiopancreatography (ERCP) is an established diagnostic and therapeutic tool in adults and older children.
  • Its utility and safety in infants (up to 1 year) require further elucidation.

Purpose of the Study:

  • To evaluate the safety and efficacy of ERCP in infants.
  • To assess the diagnostic yield and therapeutic impact of ERCP in pediatric cholestasis.
  • To determine the complication rates associated with ERCP in this specific age group.

Main Methods:

  • Retrospective analysis of 255 ERCP procedures performed over 20 years in infants up to 1 year old.
  • Procedures were indicated for cholestasis with suspected biliary obstruction.
  • Data collected included diagnoses, procedural outcomes, and complications.

Main Results:

  • The most common diagnoses were biliary atresia (48%), choledochal cysts (13%), and choledocholithiasis (4%).
  • The overall complication rate was 13.7%, with hyperamylasemia in 12.9%.
  • Severe complications occurred in only 0.8%, with no cases of postprocedural pancreatitis or mortality.

Conclusions:

  • ERCP is a safe and reliable diagnostic and therapeutic modality for infants with suspected biliary obstruction.
  • High specificity and negative predictive value for extrahepatic biliary atresia aid in preventing unnecessary surgeries.
  • ERCP facilitates timely diagnosis and endoscopic treatment for various pediatric biliary pathologies.

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