Endoscopic retrograde cholangiopancreatography in infants and children with cholestasis

Reports of ERCP in children are still limited. We present an experience with ERCP in 50 consecutive patients of the pediatric group. Children with obstructive jaundice indicated for ERCP are included in this study. ERCP was performed using the Olympus XPJ 230 in children older than one year, whereas in children less than one year old an Olympus PJF fiber duodenoscope was used. ERCP was able to diagnose 17 patients [34%] with choledochal cysts. Nine [18%] cases with choledocholithiasis either associated with hemolytic anemia or not were diagnosed and treated by ERCP [ES and stone extraction]. Fourteen cases with suspicion of EHBA were examined by ERCP and EHBA was diagnosed in 5 main out of 6 patients. In eight patients ERCP examination revealing normal biliary ductal system was very helpful and exploratory laparotomy to exclude EHBA was avoided. Two cases with parasitic worms obstructing the CBD were diagnosed by ERCP and treated also by ES and worm extraction by basket. Three cases of Caroli's disease [intrahepatic biliary radicles dilatation] were also diagnosed by ERCP and drainage of the IHBR also achieved by ES and internal biliary prosthesis placement in two of these patients. One case with sclerosing cholangitis was confirmed by ERCP. Biliary obstruction by thick inspissated bile was diagnosed and treated by ERCP in one case. Two postoperative obstruction of biliary system one case an old blocked stent was removed. The other case was diagnosed with ligated CBD and was sent back for revision of surgery. One case with congenital hepatic fibrosis and dilated IHBR on ultrasound was examined by ERCP which showed no IHBR dilatation and therefore excluding associated Caroli's disease. Only two cases with mild post ERCP, cholangitis and pancreatitis. ERCP is an important diagnostic modality in infants and children with cholestasis offering valuable detailed information on the biliary and pancreatic ductal system and it has the advantage over MRCP and CT in offering diagnostic as well as therapeutic capabilities, with very minimal complications