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Endoscopic retrograde cholangiopancreatography treatment for biliary dilatation in pediatric patients: a
Sheng Ding1, Jing-Qing Zeng1, Zhao-Hui Deng2
1Department of Gastroenterology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) is effective for pediatric biliary dilatation (BD) with mild complications. However, outcomes are limited in patients under 36 months, requiring careful consideration for this age group.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Biliary Tract Diseases
Background:
- Traditional treatments for biliary dilatation (BD) include surgical resection and choledochojejunostomy.
- Pediatric BD patients often face delays in surgical intervention.
- This study evaluates endoscopic retrograde cholangiopancreatography (ERCP) for pediatric BD.
Purpose of the Study:
- To analyze the effectiveness of ERCP in pediatric BD patients.
- To identify limitations of ERCP in this population.
- To compare ERCP outcomes based on patient characteristics.
Main Methods:
- Retrospective data collection from two centers (June 2018 - June 2022).
- Patients classified by Todani classification.
- Analysis of clinical features, ERCP procedures, complications, effectiveness, and limitations.
Main Results:
- 77 symptomatic pediatric BD patients evaluated; 68.8% had pancreaticobiliary malformation (PBM).
- ERCP performed in 74.0% (57/77) with a 75.4% effectiveness rate and mild complications.
- Younger patients (<36 months) and those with elevated liver enzymes showed poorer ERCP response.
Conclusions:
- ERCP is a viable option for pediatric BD with acceptable complication rates.
- Therapeutic outcomes are limited in pediatric BD patients under 36 months.
- Careful patient selection is crucial for ERCP in pediatric BD.
Background:
The main treatments for biliary dilatation (BD) are surgical resection and choledochojejunostomy. However, various factors lead to the postponement of early surgical intervention in pediatric BD patients. This study aimed to analyze the effectiveness and limitations of endoscopic retrograde cholangiopancreatography (ERCP) in BD pediatric patients.
Methods:
Data on patients with BD treated at two centers from June 2018 to June 2022 were retrospectively collected. Patients were categorized into five groups according to Todani classification. Clinical features, ERCP processes, ERCP-related complications, ERCP effectiveness and its limitations were reviewed.
Results:
A cohort of 77 symptomatic BD patients was evaluated, with pancreaticobiliary malformation (PBM) identified in 68.8% of cases. These patients underwent 142 hospitalizations, including 96 involving ERCP and 46 without ERCP. ERCP was performed in 74.0% (57/77) of BD patients, with a median follow-up of 26 months (range: 2-48 months), achieving an effectiveness rate of 75.4%. ERCP-related complications included post-ERCP pancreatitis (20.8%), postoperative infections (6.3%), and bleeding (2.1%). All complications were mild and managed conservatively. Further stratified analysis revealed that patients under 36 months of age at onset (P = 0.001) and those with elevated liver enzymes (P = 0.049) did not respond well to ERCP. The proportion of jaundice (P = 0.006) and biliary obstruction (P = 0.013) was significantly higher in the group with an onset age of ≤ 36 months compared to the group with an onset age > 36 months.
Conclusions:
ERCP is suitable for BD pediatric patients with mild and acceptable complications. Careful consideration is required when deciding to perform the procedure, as therapeutic outcomes are limited in patients with an onset age under 36 months.
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