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Multidisciplinary approach to the treatment of pediatric pancreaticobiliary disorders
E P Tagge1, P R Tarnasky, J Chandler
1Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.
Insights
A multidisciplinary approach combining surgery and endoscopic retrograde cholangiopancreatography (ERCP) effectively treats pediatric pancreaticobiliary disorders. This collaborative method ensures successful diagnosis and management for children with complex conditions.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Endoscopic Procedures
Background:
- Pancreaticobiliary disorders in children require specialized multidisciplinary care.
- Traditional surgical approaches are complemented by advanced endoscopic techniques.
Purpose of the Study:
- To evaluate the efficacy of a multidisciplinary approach for diagnosing and treating pediatric pancreaticobiliary disorders.
- To assess the role of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric management.
Main Methods:
- Retrospective chart review of 26 pediatric patients (6 months to 19 years) treated between June 1990 and May 1995.
- Analysis of disease processes, symptoms, laboratory data, surgical/endoscopic procedures, and outcomes.
- Inclusion of patients who underwent ERCP as part of their treatment.
Main Results:
- ERCP successfully visualized the pancreaticobiliary tree in 96% of patients.
- Therapeutic endoscopic procedures were successful in 87% of cases.
- Successful endoscopic extraction of common bile duct stones in 10 patients, including an infant; 96% overall survival rate.
Conclusions:
- A multidisciplinary approach integrating surgery and ERCP is effective for pediatric pancreaticobiliary disorders.
- Diagnostic ERCP and therapeutic endoscopic interventions are feasible and beneficial in pediatric patients.
- This collaborative strategy simplifies the management of complex pediatric pancreaticobiliary conditions.
Abstract:
A multidisciplinary approach using traditional open surgery, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery has revolutionized the care of the adult with pancreaticobiliary disease. This study focuses on a similar collaborative effort to diagnose and treat children with pancreaticobiliary disorders. Charts of all patients treated on the pediatric surgery service between June 1990 and May 1995, who also underwent ERCP, were abstracted for disease process, presenting symptoms, laboratory evaluation, surgical or endoscopic procedures, and eventual outcome. Twenty-six children were identified, ranging from 6 months to 19 years of age. Pancreaticobiliary disorders included pancreas divisum (n = 1), choledochal cyst (n = 4), pancreaticobiliary trauma (n = 4), cholelithiasis and choledocholithiasis (n = 17). The pancreaticobiliary tree was successfully visualized by ERCP in 25 of 26 (96%) patients. Fifteen of these patients also underwent attempted therapeutic endoscopic procedures, with 13 (87%) performed successfully. Three patients with choledochal cyst had stents placed preoperatively for cholangitis, all of whom have undergone successful choledochal cyst excision. Two trauma patients underwent attempted stenting of a bile leak and bile duct stricture, respectively, both of which were unsuccessful, necessitating surgical correction. Seventeen patients with cholelithiasis underwent ERCP to rule out choledocholithiasis. Ten patients were found to have common duct stones, and all stones were endoscopically extracted, including those in a 6-month-old child. Overall survival rate was 96% (25 of 26), with the one death occurring in a trauma patient unrelated to his pancreaticobiliary disorder. A multidisciplinary approach using traditional open surgery, ERCP and laparoscopic surgery can successfully treat even young children with pancreaticobiliary disorders. In experienced hands, diagnostic ERCP and therapeutic endoscopic intervention can be performed successfully in most pediatric patients, greatly simplifying the surgical management of these potentially complex problems.