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Endoscopic Retrograde Cholangiopancreatography in Bangladeshi Children: Experiences and Challenges in a Developing
Rafia Rashid1, Md Samsul Arfin2, A S M Bazlul Karim3
1Department of Pediatric Gastroenterology, Dr. MR Khan Shishu Hospital and Institute of Child Health, Dhaka, Bangladesh.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) is effective for Bangladeshi children with liver, pancreas, and bile duct diseases. Experienced endoscopists ensure successful diagnostic and therapeutic outcomes in pediatric patients.
Area of Science:
- Gastroenterology
- Pediatric Endoscopy
- Hepatopancreaticobiliary Diseases
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is a long-established procedure.
- Its application in pediatric patients in Bangladesh is a recent development.
- There is a need to document the experience and efficacy of ERCP in this population.
Purpose of the Study:
- To describe the experience of performing ERCP in Bangladeshi children.
- To analyze the spectrum of hepatopancreaticobiliary diseases in these pediatric patients.
- To evaluate the diagnostic and therapeutic efficacy of ERCP in this cohort.
Main Methods:
- A retrospective review of 30 ERCP procedures performed on 20 children between 2018 and 2021.
- Procedures were conducted by a single trained adult gastroenterologist using a therapeutic video duodenoscope.
- Data collected included indications, diagnostic findings, therapeutic interventions, and complications.
Main Results:
- The median age of patients was 10 years; successful cannulation was achieved in 28 procedures.
- Common indications included choledocholithiasis for biliary issues and chronic pancreatitis for pancreatic issues.
- Therapeutic interventions included sphincterotomy, stenting, stone extraction, and balloon dilatation, with an uneventful post-procedural period.
Conclusions:
- ERCP is a practical and successful therapeutic option for pediatric hepatopancreaticobiliary disorders.
- Experienced endoscopists are crucial for achieving positive outcomes.
- This study highlights the utility of ERCP in managing complex pediatric gastrointestinal conditions in Bangladesh.
Purpose:
Although endoscopic retrograde cholangiopancreatography (ERCP) has been used for more than five decades, its applicability in Bangladeshi children has recently become more common. Therefore, this manuscript aims to describe our experience in performing ERCPs in Bangladeshi children with hepatopancreaticobiliary diseases, focusing on presenting diseases, as well as the diagnostic and therapeutic efficacy.
Methods:
Between 2018 and 2021, 20 children underwent 30 ERCP procedures at the Bangladesh Specialized Hospital, Dhaka. A single trained adult gastroenterologist performed all procedures using a therapeutic video duodenoscope. The indications for ERCP, diagnostic findings, therapeutic procedures, and complications were documented.
Results:
The median age of the study patients was 10 years (range, 1.7-15 years). Successful cannulation of the papilla was achieved in 28 procedures and failed in 2 cases. Repeated ERCP was required in seven patients. Nine patients had biliary indications and 11 had pancreatic indications. Choledocholithiasis was the most common indication for ERCP in patients with biliary disease, while chronic pancreatitis was common among patients with pancreatic indications. Pancreatic divisum was observed in only one patient. Pancreatic and biliary sphincterotomy was performed in 14 and 9 cases, respectively. A single pigtail or straight therapeutic stent was inserted in seven cases and removed in five cases. Stone extraction was performed in six procedures, and balloon dilatation was performed in five procedures. The post-procedural period for these patients was uneventful.
Conclusion:
We found that ERCP is a practical and successful therapeutic intervention for treating hepatopancreaticobiliary disorders in children when performed by experienced endoscopists.
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