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Endoscopic retrograde cholangiopancreatography in children
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) is effective for diagnosing and treating pediatric pancreaticobiliary diseases. This study shows ERCP is safe and useful in children, identifying various structural abnormalities.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is standard for adult pancreaticobiliary disease.
- Its application in pediatric patients remains limited.
Purpose of the Study:
- To evaluate the utility and safety of ERCP in children and adolescents.
- To identify common pancreaticobiliary conditions in this age group.
Main Methods:
- ERCP was performed on 39 pediatric patients (6 months to 18 years).
- Procedures included manometry, sphincterotomy, and stone extraction.
- Standard adult and pediatric endoscopes were utilized.
Main Results:
- Nineteen patients (48.7%) had significant structural findings.
- Diagnoses included pancreas divisum, sclerosing cholangitis, choledochal cysts, and sphincter of Oddi dysfunction.
- ERCP provided crucial anatomical detail for surgical planning.
Conclusions:
- ERCP is a valuable diagnostic and therapeutic tool for pediatric pancreaticobiliary disorders.
- The procedure demonstrated a favorable safety profile with mild pancreatitis as the main complication.
Abstract:
Endoscopic retrograde cholangiopancreatography (ERCP) is a universally used diagnostic and therapeutic modality in adults with pancreaticobiliary tract disease; its use in children with similar problems has been limited. We have performed ERCP procedures in 39 children and adolescents (aged 6 months to 18 years; mean 12.5 years), using the standard adult and pediatric side-viewing endoscopes. In selected cases, ERCP manometric study of the sphincter of Oddi, endoscopic sphincterotomy, or balloon extraction of common bile duct stones was performed. Nineteen patients had significant or abnormal structural findings, including pancreas divisum (four patients); sclerosing cholangitis (three); and choledochal cyst, chronic pancreatitis, choledochocele, pancreatic pseudocyst, common bile duct stone, and sphincter of Oddi motor dysfunction (two each). In all instances in which patients required operation, ERCP examination provided specific anatomic detail that was useful for planning appropriate intervention. The only significant complication after ERCP was mild pancreatitis, which occurred in four patients and responded to supportive, short-term measures.