Endoscopic retrograde cholangiopancreatography in children.

Gastroduodenoscopy and retrograde cholangiopancreatography has been performed on 25 occasions in 20 children aged between 7 and 16. Radiographs of the clinically relevant duct or ducts were achieved in 96% of attempts, with no complications. The diagnostic information proved useful clinically; in particular it provided a precise map if biliary or pancreatic surgery was being contemplated. Several unexpected congenital duct anomalies were found. This and other recent reports, particularly from Germany, indicate that endoscopic retrograde cholangiopancreatography deserves greater application in children, and can also be used in babies.     

Endoscopic retrograde cholangiopancreatography in children and adolescents

OBJECTIVES: Endoscopic retrograde cholangiopancreatography (ERCP) is becoming a more frequently used diagnostic and therapeutic tool in children. We sought to determine the indications, feasibility, safety, and effect on patient management of ERCP in pediatric patients of varying age. METHODS: All ERCPs performed during a 4-year period in patients aged 18 years or less at an academic hospital were retrospectively reviewed. The indications, type of anesthesia administered, type of duodenoscope used, diagnostic findings, therapeutic interventions, complication rate, and effect on management were compared between children (age 0-12 years) and adolescents (age 13-18 years). RESULTS: A total of 53 procedures were performed in 43 patients whose median age was 13.5 years. ERCP was successful in 50 of 53 cases (94%) with a complication rate of 6%. Endoscopic therapy was provided in 24 of 53 cases (45%). Compared with adolescents (n = 28), children (n = 25) were more likely to receive general anesthesia (96% vs. 29%; P < 0.001) and undergo ERCP with a pediatric duodenoscope (0% vs. 40%). ERCP affected management in 73% of cases, equally in both groups. CONCLUSION: ERCP is a successful and safe diagnostic and therapeutic modality in a variety of pancreatobiliary disorders that directly affects management in children of all ages.     

Endoscopic retrograde cholangiopancreatography in infantile cholestasis.

The difficulty of distinguishing surgically correctable causes of conjugated hyperbilirubinaemia in infants from other causes means that some infants may undergo laparotomy and intraoperative cholangiography unnecessarily, and others may be referred for surgery too late. In an attempt to improve the diagnostic accuracy in infants with conjugated hyperbilirubinaemia when standard methods produced equivocal results, we have been using prototype paediatric duodenoscopes (PJF 7.5 and XPJF 8.0; Olympus) to perform endoscopic retrograde cholangiopancreatography (ERCP). From 159 infants with conjugated hyperbilirubinaemia, 11 were referred for ERCP, which was performed in nine. In four in whom bile ducts were definitely visualised laparotomy was avoided. Operative cholangiography confirmed patent bile ducts in one in whom visualisation had been uncertain. Three of four in whom bile ducts were not seen had extrahepatic biliary atresia. Visible bile drainage in the fourth excluded atresia. No major complications ensued but there was radiological evidence of gall bladder perforation in one (common hepatic duct block) and overinflation with air was a problem until finer cannulae (Wilson-Cook) were introduced. In appropriately selected patients with conjugated hyperbilirubinaemia, ERCP with paediatric duodenoscopes in experienced hands may provide useful diagnostic information.     

小儿经内镜逆行胰胆管造影术的临床应用

随着儿科内镜技术的发展,小儿经内镜逆行胰胆管造影术(ERCP)开始得到重视,它具有提供详细胰胆管系统的解剖和功能信息优点,是胰胆管疾病因诊断及鉴别诊断的重要手段,而治疗性ERCP如括约肌切开术、取石术、支架植入及鼻胆管引流术也逐渐应用于临床,其并发症少、死亡率低、重复性好,具有广阔的应用前景.     

经内镜逆行胰胆管造影术在儿童胰胆疾病中的应用进展

经内镜逆行胰胆管造影术(ERCP)是胰胆疾病诊断和治疗的重要手段,可对各种原因所致的梗阻性黄疸、胆管结石、胰胆管异常、急慢性胰腺炎等多种疾病进行诊断和治疗。随着内镜诊治技术的发展,ERCP在儿童胰胆疾病中的应用逐渐增多,主要集中在儿童先天性胰胆疾病和急慢性胰腺炎。现就近年来ERCP在儿童胰胆疾病诊治中的应用进展进行综述。     

Endoscopic retrograde cholangiopancreatography is safe and effective for the diagnosis and treatment of pancreaticobiliary disease following abdominal organ transplant in children

Otto AK, Neal MD, Mazariegos GV, Slivka A, Kane TD. Endoscopic retrograde cholangiopancreatography is safe and effective for the diagnosis and treatment of pancreaticobiliary disease following abdominal organ transplant in children. Abstract: ERCP is a diagnostic and therapeutic imaging modality widely used in adult pancreaticobiliary disease, including the treatment of anastomotic strictures following liver and small bowel transplant. We have previously reported a large series of ERCP in children and demonstrated its safety and utility in pediatric disease. The aim of this study was to evaluate the safety of and indications for ERCP following abdominal organ transplant among pediatric patients by performing a subgroup analysis of our large cohort. Forty‐eight ERCPs were performed on 25 children ages 62 days to 20 yr following isolated liver, isolated small bowel, or composite graft transplant. Mean time from transplantation at the time of ERCP was 18 months. The most common indication for ERCP was the evaluation of non‐specific hepatobiliary complaints, including abdominal pain and elevated liver enzymes. ERCP was also commonly performed for the evaluation or treatment of known or suspected biliary tree strictures. Seventy‐seven percent of cases included therapeutic intervention, including sphincterotomy in 40%, stent placement in 29%, and stone extraction in 19%. The overall complication rate among post‐transplant patients was low (2.9%) and not significantly different than the complication rate reported in our previous study. A history of abdominal organ transplant was not associated with an increased risk of complication following ERCP (OR = 0.41, 95% CI = 0.05–3.33). In our experience, ERCP can be safely performed in children following liver, small bowel, and composite graft transplant with outcomes similar to those seen in a general pediatric population and may be especially useful for the diagnosis and treatment for biliary strictures following transplant. Further investigation of the relationship between the timing of ERCP relative to transplant and the safety of the procedure is needed.     

Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography in children: a large series report

OBJECTIVES: Our goal is to evaluate the indications, findings, therapies, safety, and technical success of endoscopic retrograde cholangiopancreatography (ERCP) in children. METHODS: Our database was searched for patients 17 years of age or younger undergoing ERCP between January 1994 and March 2003. Additional information was obtained by chart review. The safety and technical success of ERCP were examined. Complications were classified by the consensus criteria. RESULTS: A total of 245 patients (95 M, 150 F; mean age 12.3 years) underwent 329 examinations. Indications included biliary pathology (n = 93), pancreatic pathology (n = 111), and chronic abdominal pain of suspected biliary or pancreatic origin (n = 41). The ERCP findings were bile duct stone(s) (n = 29), benign biliary stricture (n = 19), primary sclerosing cholangitis (n = 7), anomalous pancreaticobiliary union (n = 8), choledochal cyst (n = 5), bile duct leak (n = 6), malignant biliary stricture (n = 2), biliary atresia (n = 1), chronic pancreatitis (n = 44), pancreas divisum (n = 26), pancreatic duct stricture with (n = 6) or without (n = 9) leak, pancreatic tumor (n = 1), periampullary adenoma (n = 2), and sphincter of Oddi dysfunction (n = 65). Endoscopic therapies were performed in 71% of the procedures and included sphincterotomy, stone extraction, stricture dilation, endoprosthesis placement, snare papillectomy, and cystoduodenostomy. Thirty-two (9.7%) post-ERCP complications occurred and included cholangitis in 1 patient and pancreatitis in 31. The pancreatitis was graded mild in 24, moderate in 5, and severe in 2. No mortality related to ERCP occurred. CONCLUSIONS: Diagnostic and therapeutic ERCP results are similar in children and adults except for a lower incidence of malignant disease in children. Technical success rates are high. However, ERCP-related pancreatitis is not uncommon, and the risk and benefits should be carefully reviewed before proceeding. Outcome data are necessary and is currently being accumulated at our institution.     

Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in children and adolescents: experience in a single institution

INTRODUCTION: Experience in the use of endoscopic retrograde cholangiopancreatography (ERCP) for the investigation and treatment of pancreaticobiliary disorders is relatively limited in children. This report reviews the experience in a single institution with pediatric ERCPs and documents the indications, success rate, diagnostic and therapeutic yields, complications, and the impact on patient management. PATIENTS AND METHODS: The data of all consecutive patients aged < or = 18 years who underwent ERCP procedures between the years 1997 and 2007 were retrospectively identified through a computer database search. The database prospectively recorded the indications, findings, therapies, and complications. RESULTS: During the study period, 32 ERCP procedures were performed in 28 children with a median age of 13 (range 8 - 18) years. ERCPs were performed for biliary pathology in 21 (75 %) and for pancreatic pathology in 7 (25 %) patients. The most common biliary indications were suspected choledocholithiasis and postoperative bile leaks. Hydatid disease was the most common diagnosis that yielded bile leaks. The pancreatic indications were recurrent pancreatitis and traumatic pancreatic duct disruption. Cannulation of the desired duct was successful in all procedures. An endoscopic sphincterotomy, stone/sludge removal or a stent placement was performed in 20 (63 %) procedures. According to the long-term follow-up, avoidance from any further surgical interventions was achieved in 11 (65 %) children, in whom ERCP was undertaken as a therapeutic intervention. The complication rate was 6 % with the development of mild self-resolving pancreatitis in one patient and stent occlusion in another. CONCLUSIONS: ERCP in the pediatric population has a high success rate, both as a diagnostic tool and for therapeutic interventions, provided it is performed by experienced endoscopists. The delicate delineation of the anatomy by ERCP and its therapeutic potential make it absolutely superior to other less invasive tools such as magnetic resonance cholangiopancreatography.     

ERCP在儿童化脓性梗阻性胆管炎治疗中的应用价值

急性化脓性梗阻性胆管炎(acute obstructive suppurative cholangitis,AOSC)是由于急性胆管梗阻并继发化脓性感染所致,是肝外胆道梗阻的一种严重并发症.本病起病急骤,病情复杂而进展迅速,并发症多而且病死率高.对急性化脓性梗阻性胆管炎的治疗以手术尽早解除梗阻,减压引流胆道为主[1-3].2013年3月至2013年12月,我科应用内镜下进行胰胆管造影术(endoscopic retrograde cholangiopan-creatography,ERCP)+十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)+内镜下鼻胆管引流(endoscopic nasobiliary drainage,ENBD)治疗化脓性胆管炎3例,现将3例患儿的治疗过程总结如下.     

Magnetic resonance cholangiopancreatography in primary sclerosing cholangitis in children

BACKGROUND: Primary sclerosing cholangitis (PSC) is a chronic cholestatic syndrome of unknown aetiology. Diagnosis is based on clinical and laboratory data in conjunction with imaging of the biliary tree using endoscopic retrograde cholangiopancreatography (ERCP). OBJECTIVE:: To evaluate the clinical usefulness of MR cholangiopancreatography (MRCP) in the diagnosis of PSC in children. MATERIALS AND METHODS: Twenty-one children with clinical and laboratory suspicion of PSC were enrolled. MRCP was performed using a superconductive system with a phased-array coil. Rapid acquisition with relaxation enhancement (RARE) T2-weighted and half-Fourier single-shot turbo-spin-echo (HASTE) sequences were used. The distribution and extent of biliary tree changes were evaluated and classified according to Majoie's classification. A comparison between MRCP and ERCP was performed blind in all cases to evaluate the usefulness of MRI. RESULTS: In 13 cases (62%), MRCP showed abnormalities of the biliary tree which were considered positive for PSC, while in 8 cases there were no signs of PSC. Both MRCP and ERCP correctly identified changes in 13 cases and excluded abnormalities in 5. MRCP had a sensitivity of 81%, specificity of 100%, negative predictive value of 62%, positive predictive value of 100% and an accuracy of 85%. CONCLUSIONS: MRCP can be proposed as the preliminary non-invasive imaging modality for the diagnosis of PSC in children.     

ERCP和MRCP在儿童胆胰疾病中的应用与评估

目的：探讨经内窥镜十二指肠孔头插管进行胰胆管造影（ERCP）和磁共振胰胆管造影（MRCP）在我国小儿胰胆疾病中应用的价值。方法：分析41例接受ERCP检查的患儿B超,CT,ERCP和MRCP的检查结果和ERCP的并发症,并和手术结果进行比较。结果：ERCP显示36例胆总管扩张,3例胆总管结石,1例反复发作的胰腺炎,胰管扩张,1例阴性;MRCP检查23例,胆管扩张20例,胆总管结石2例,阴性1例,ERCP的敏感性和特异性分别为95＝1％,97．4％,MRCP的敏感性和特异性为94．6％,94．8％,3例发生ERCP后并发症,主要是胰腺炎,发生率为4．6％,结论：ERCP和MRCP对小儿胰胆系统疾病的影像学诊断有很高的敏感性和特异性,可作为明确诊断的常规方法。     

MR cholangiopancreatography findings in children with spontaneous bile duct perforation

Background  

Spontaneous bile duct perforation (SBP) is rare in children. Early diagnosis is important because the condition can be treated surgically.     

青少年腔镜甲状腺切除术

目的探讨青少年腔镜甲状腺切除术的可行性与疗效。方法回顾分析12例经胸部途径胸骨前入路腔镜甲状腺切除术治疗青少年甲状腺疾病，对青少年腔镜甲状腺切除术的手术适应证、手术方法、疗效等进行讨论。结果12例成功完成胸骨前入路腔镜甲状腺切除术，术中、术后无大出血、纵隔气肿及喉返神经损伤等严重并发症；术后随访3～48个月，无复发。结论经胸部途径腔镜甲状腺切除术治疗青少年甲状腺疾病安全可行，术后颈部无瘢痕，美容效果好，但要注意手术适应证的选择。