Diagnostic and Therapeutic Efficacy of Endoscopic Retrograde Cholangiopancreatography in Children

ABSTRACT

PURPOSE: Endoscopic retrograde cholangiopancreatography (ERCP) may provide more definite diagnosis, preoperative guidance, and endoscopic therapy in many children with known or suspected disorders of the pancreas and biliary tract. But the reports about the ERCP in children are rare, so this study is conducted to evaluate the indication, efficacy and safety of the ERCP in children. METHODS: Twenty nine ERCPs in 19 children were included in this study from July, 1994 to Dec, 1996. The children were nine boys and ten girls and their mean age was 6.9 years old (24 months-14 years). The examination was performed in 16 children under general anesthesia while the other 3 adolescent under conscious sedation with Olympus JF or JF1T duodenoscope. We evaluated the indication, efficacy and complication of the ERCPs. RESULTS: All cannulations were successful except one and endoscopic sphincterotomy (EST) was done in 12 children. Among 19 children, we could confirm the clinical diagnosis in 6, add the additional information in 5, revise the diagnosis in 4 (operation guidance in 3), but give no diagnosis in 4 even after ERCP. The diagnosis after ERCPs are choledochol cyst (4), choledochocele (1), bile duct stricture (1), GB and CBD stone (1), pancreatitis with biliary sludge (5), chronic pancreatitis (2) and pancreatic fistula (1). We could achieve therapeutic goal in 8 children after therapeutic ERCP in 11 children. As complications of ERCP, pancreatitis developed in 2 children, moderate delayed hemorrhages requiring transfusion in 2, retroduodenal perforation in 1 and cholangitis in 1 child. No fatality was observed and all complications improved after supportive cares. Most of the complications developed after EST. CONCLUSIONS: All ERCPs were successful, although most of them were done under general anesthesia. In this study we could conclude that ERCP may provide more definite diagnosis, preoperative guidance, and endoscopic therapy in many children with known or suspected disorders of the pancreas and biliary tract. But special care should be paid especially after EST.