Endoscopic retrograde cholangiopancreatography in infants and children

A single institutional experience with endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients was reviewed, focusing on the method of anesthesia, choice of an endoscope, indications, and complications. The medical records of 50 ERCPs performed in 42 infants and children (14 male and 28 female) were reviewed retrospectively. The patients' ages ranged from 57 days to 15 years. Forty-four ERCPs were diagnostic and 6 were therapeutic, including incision of choledochocele, and sphincterotomy and extraction of pancreatic stones. All procedures were successful. The most common indication for ERCP was to evaluate congenital biliary dilatation, in 28 patients (67%). Mild cholangitis occurred as a complication in 1 patient, but was alleviated with medication. A conventional duodenoscope could be used in patients older than 10 years. A pediatric duodenoscope was always used in patients under 1 year of age. Either type was chosen individually for those aged 1 to 10 years depending on the purpose, diagnostic or therapeutic. It is noteworthy that ERCP and/or sphincterotomy in a 1-year-old infant and two 2-year-old children were safely performed with the conventional endoscope. General anesthesia was employed in those younger than 9 years and intravenous sedation and local anesthesia in those older than 11 years. For children aged 9 to 11 years, anesthesia was chosen individually. We concluded that ERCP is a relatively easy and safe technique even for infants and children when performed by skilled hands with an appropriate duodenoscope under suitable anesthesia. The minimum age for use of the conventional duodenoscope may be 1 year. Received: February 1, 1999 / Accepted: July 23, 1999     

Endoscopic retrograde cholangiopancreatography in childhood.

ERCP was performed in 19 children and adolescents aged 4 to 16 years. In 13 children the examination was done under general anesthesia, in 6 cases with the usual premedication using dolsin and atropine. Indications for examination were unclear abdominal pain with occasional amylase elevation, in 3 patients status after an abdominal injury. In 16 patients the examination clarified the complaints by detecting organic disease of the gallbladder or the pancreas. ERCP is an important procedure in the event of uncertain diagnosis in children and adolescents and, if the indication is correct, and the technique good, is well tolerated by the patients.     

Endoscopic retrograde cholangiopancreatography in familial pancreatitis.

A young man and his father, both with pancreatitis, were recently seen at the Mayo Clinic. The histories, physical findings, and laboratory values were those of chronic pancreatitis. Endoscopic retrograde cholangiopancreatography was valuable in confirming the gross pathological changes and in orienting the surgeon preoperatively.     

Endoscopic retrograde cholangiopancreatography in elderly patients.

BACKGROUND: the presentation of common bile duct disease, value of investigations and treatment outcome in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were assessed. METHODOLOGY: the clinical presentation, liver function tests, full blood counts, abdominal ultrasound and ERCP results were assessed retrospectively in 101 patients (59 women, 42 men; mean age 83 years, range 75-100) sequentially investigated for possible common bile duct disease. RESULTS: 59 patients had common bile duct gallstones, 35 had malignant biliary obstruction (13 with co-existing common bile duct stones) and seven had other outcomes. In the malignant-alone group 68% of those who had jaundice presented painlessly compared with 24% in the gallstones-alone group; 49% of the gallstones-alone group had pain compared with 28% of the malignant group. In the gallstones-alone group 43% had atypical presentations (non-specific symptoms or painless jaundice). Non-specific symptoms were found in 19% of the gallstones-alone group but in only 5% of the malignant group. Of the patients who had common bile duct stones, 18% had pancreatic or biliary malignancy. The co-existence of gallstones and malignancy was emphasized by eight patients in whom the clinical and ultrasound diagnosis was of common bile duct stones but malignancy was detected by ERCP. The sensitivity of ultrasound was 86% for detecting dilated common bile ducts was 86%, but only 69% for diagnosing gallstones within the common bile duct and 67% for diagnosing pancreatic masses. Ultrasound and ERCP were in agreement in 60 patients (60%). Endoscopic clearance of common bile duct gallstones was successful in 53 of 54 attempts (98%). Palliative ERCP treatment was performed in 30 patients who had malignant biliary obstruction and was successful in 22 (73%); in a further four patients (13%) an endoprothesis was successfully inserted percutaneously. The commonest complication of ERCP was cholangitis (four patients); pancreatitis and biliary perforation occurred in one patient each. Twenty-two patients (63%) who had malignancy died during follow-up, the mean survival being 11.3 weeks (range 3 days-2 years). Carcinoma of the ampulla was associated with a relatively good prognosis (three patients survived 18 months or more). CONCLUSION: in elderly patients, common bile duct stones often present atypically and co-existence with malignancy is not unusual; ampullary carcinoma has a relatively good prognosis and ERCP is a safe and effective procedure in the management of biliary obstruction.     

Endoscopic retrograde cholangiopancreatography in pediatrics

Endoscopic retrograde cholangiopancreatography (ERCP) is a useful, although understudied, tool in the diagnosis and treatment of pancreaticobiliary disease in pediatric populations. Although appropriately sized equipment is somewhat limited, 7.5-mm duodenoscopes are available and can be used in even the smallest infants along with a small array of devices to fit through the 2.0-mm channel. Indications for ERCP in children are similar to those in adults and include therapy of biliary and pancreatic ductal obstruction or disruption, although the etiologies of the obstructions may differ greatly between the 2 populations. Rates of complications and procedural success are similar in pediatric and adult patients. Historically, most pediatric ERCPs have been performed by experienced adult endoscopists, but during the past 15 years, there has been increased interest in pursuing therapeutic endoscopy training among pediatric gastroenterologists. Prospective multicentered studies at pediatric centers will help define the role of pediatric ERCP in the treatment of children with pancreatic and biliary disease.     

ERCP诊治胆管乳头状瘤

目的 探讨ERCP在诊治胆管乳头状瘤中的临床应用价值.方法 回顾性分析2000年1月至2008年12月ERCP检查时发现的6例胆管乳头状瘤患者的临床资料.结果 6例患者中男性3例,女性3例,年龄52～83岁,平均72.8岁.患者均表现为复发性胆管炎或黄疸,其中表现为持续性右上腹疼痛5例,腹痛伴有皮肤、巩膜黄染4例,伴有寒战、高热3例.2例曾行部分肝叶切除术.5例在内镜下可见十二指肠乳头肿大,肿大的乳头开口类似鱼嘴样改变;1例见乳头占位性病变;乳头内均可见透明胶冻状粘液流出.造影下6例均表现为胆总管扩张,合并肝外胆管扩张3例,合并右肝内胆管扩张、主胰管扩张各1例.扩张的胆管内可见不规则、絮状飘浮的充盈缺损影,取石球囊清理胆道时常可见充盈缺损形状改变.5例多次行ERCP术,于内镜下置入内支架或行鼻胆管引流术(ENBD),已存活10～30个月.1例83岁患者球囊、网篮清理胆道、ENBD 10 d后死于胆管炎.结论 ERCP在胆管乳头状瘤诊断中具有典型的内镜学及影像学特征;对于术后复发或失去手术机会的患者,内镜下治疗是一种安全、方便、有效的方法.     

Endoscopic retrograde cholangiopancreatography in pancreatic trauma

The sensitivity and specificity of ERCP for the diagnosis of suspected pancreatic ductal rupture was prospectively studied. Fourteen consecutive patients who were referred for abdominal pain and hyperamylasemia subsequent to abdominal trauma underwent ERCP, the majority within 24 hours of admission. Twelve of these also underwent abdominal CT, and 7 had peritoneal lavage. Four patients were found to have ductal rupture at ERCP. This was confirmed at laparotomy. Three additional patients who underwent laparotomy were found not to have a ductal rupture, although one had a pancreatic capsular laceration. The remaining 7 had clinical resolution. ERCP was 100% sensitive and specific in the diagnosis of pancreatic ductal rupture, whereas no combination of serum amylase, CT scan, and peritoneal lavage was equally effective.     

Endoscopic retrograde cholangiopancreatography in Sudanese diabetics

Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 40 Sudanese patients with diabetes mellitus. 25 were insulin-dependent and 15 were noninsulin-dependent. ERCP was normal in all the patients with insulin-dependent diabetes. Two patients with noninsulin-dependent diabetes had pancreatographic changes compatible with minimal-change pancreatitis. Diabetes mellitus in Sudan unlike in other tropical countries is not associated with structural changes in the exocrine pancreas.     

Endoscopic retrograde cholangiopancreatography in the management of pancreaticobiliary disorders in children

BACKGROUND AND AIM: The role of endoscopic retrograde cholangiopancreatography (ERCP) is not yet fully established in children. The purpose of this study was to assess the use of ERCP in the diagnosis and management of various pancreaticobiliary disorders in children. METHODS: Eighty-four ERCPs were performed over 5.5 years in 72 children with suspected pancreaticobiliary tract disorders with an adult-type duodenoscope. In all cases, indications, procedure time, ERCP findings, complications, patients course and therapeutic intervention (if any) were recorded. RESULTS: The mean (+/- SD) age of these children was 8.8 +/- 3.3 years. Successful cannulation was possible in 70 (97%) cases. Of the 44 cases with suspected biliary tract disease, 14 had a choledochal cyst, 13 had portal biliopathy, two each had CBD stones, primary sclerosing cholangitis and a bile leak, one had biliary ascariasis, eight had a normal cholangiogram, and CBD cannulation failed in two. Eight of the 28 children with suspected pancreatic disorders had chronic pancreatitis, five had pancreatic duct disruption, three had pancreas divisum and the rest had a normal pancreatogram (including all eight children with unexplained abdominal pain). Therapeutic ERCP was performed in 22 children, endoscopic nasobiliary or a nasocystic drain was placed in 16, biliary stenting was conducted in two, pancreatic duct stenting was conducted in three, and minor papilla dilation was conducted in one child. Six children had mild procedure-related complications. CONCLUSION: Endoscopic retrograde cholangiopancreatography is very useful in the treatment of cholangitis, bile leak, pseudocyst and pancreatic fistulae in children. However, its role in unexplained abdominal pain is doubtful.     

Endoscopic retrograde cholangiopancreatography in pancreatic and biliary tract disease in Korean children

AIM:To assess the indications,findings,therapeutic procedures,safety,and complications of endoscopic retrograde cholangiopancreatography(ERCP) performed in Korean children.METHODS:The demographic characteristics,indications for ERCP,findings,therapeutic procedures,and complications of 122 pediatric patients who underwent 245 ERCPs in the Asan Medical Center between June 1994 and March 2008 were investigated.RESULTS:The mean age of the 122 patients was 8.0 ± 4.2 years.Indications were biliary pathology in 78...     

Endoscopic retrograde cholangiopancreatography in hepatic alveolar echinococcosis

Background and Aim:  Hepatic alveolar echinococcosis (HAE) involves both the vascular and biliary structures of the liver. Endoscopic retrograde cholangiopancreatography (ERCP) is said to be an alternative for the diagnosis and treatment of biliary complications of HAE. We present here our experience with ERCP in HAE.
Methods:  We followed 13 patients who underwent ERCP for the treatment of biliary complications of HAE in the endoscopy unit of our clinic at Ataturk University School of Medicine, Erzurum between January 2002 and June 2008.
Results:  Eight men and five women were followed up. Mean age was 43.2 (24–64 years). All patients had non-resectable HAE. Indications for ERCP were biliary fistula in seven patients, obstructive jaundice in five patients and cholangitis in one patient. Endoscopic sphincterotomy (ES) was carried out in 12 patients, and in one patient with biliary leakage, a stent was inserted into the right hepatic branch. ERCP findings were dilated common bile duct, irregular narrowing and distortion of the common bile duct and common hepatic duct, communication with the cystic cavity or biliocutaneous fistula and complete disappearance of the biliary tree above the level of the common hepatic duct or hepatic bifurcation. In patients with biliary leakage, biliary drainage decreased only in two patients after ERCP and in patients with obstructive jaundice, the high bilirubin levels decreased in only one patient.
Conclusion:  ERCP showed structural changes of the external biliary tract and ES has a limited effect on these changes and stents can be used in selected cases.     

Endoscopic retrograde cholangiopancreatography in Mirizzi's syndrome]

Mirizzi's syndrome is characterized by compression and or stenosis of the common duct as a consequence of impaction of a stone in the gallbladder neck, the cystic duct and eventually by a cholecystobiliary fistula. Preoperative diagnosis is important to avoid iatrogenic injury of the biliary tree. We present two cases with Mirizzi's syndrome confirmed at operation in whom ERCP was done prior to the operation. In one of them the examination was diagnostic, while in the other, cystic duct compression and absence of the gallbladder image were the non-specific findings.     

Endoscopic retrograde cholangiopancreatography biliary tissue sampling

Confirming suspected pancreaticobiliary malignancy expedites treatment options. Narrowed ducts and periductular fibrosis may, however, limit tissue acquisition to achieve a definitive diagnosis. Based on clinical presentation, the pretest probability of malignancy often determines the approach and extent of evaluation. The least technically demanding technique that is safe, simple, and relatively inexpensive is brush cytology; however, when used alone, it often has an unacceptably low sensitivity. Endobiliary forceps biopsies have demonstrated higher rates for cancer detection but are more technically challenging. At the index procedure, multimodality sampling that involves combining at least 2 sampling techniques (typically brushings and biopsies) should be routinely performed, given a higher rate for detecting malignancy. For indeterminate biliary strictures, cholangioscopy visualization combined with directed biopsies, appears to significantly improve the diagnostic yield of endoscopic retrograde cholangiopancreatography sampling. However, although data are available suggesting superiority to brush cytology and conventional forceps biopsy, data from randomized controlled trials are lacking. Further, the role of advanced mucosal imaging and molecular studies continue to evolve.     

Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic visualization of the papilla of Vater was achieved in 98 of our first 100 attempts. Cannulation was successful in 87% of cases, achieving pancreatography alone in 29, cholangiography alone in 27, and both in 31. The relevant duct was adequately visualized in 72.5% of patients with biliary tract disease and in 72% of those with pancreatic disease. Complications were acceptably few. The procedure has proven valuable in difficult cases of obstructive jaundice and biliary type pain syndromes without jaundice. Many questions remain, however, as to its value in the diagnosis and evaluation of pancreatic disease.