The application of endoscopic retrograde cholangiopancreatography in children with pancreaticobiliary diseases / 中华实用儿科临床杂志

ABSTRACT

Objective To evaluate the clinical value and safety of endoscopic retrograde cholangiopancreatog-raphy(ERCP)in children with pancreaticobiliary diseases. Methods Retrospective review was conducted for the data of 196 patients younger than 18 years old who underwent ERCP between January 2008 and June 2016 at Shanghai Rui-jin Hospital Affiliated to School of Medicine,Shanghai Jiaotong University. The data of indications,pathogenesis,thera-py,complications were collected and the relationship between ERCP treatment methods and post - operation complica-tions was analyzed. Results A total of 314 ERCP procedures were performed on 196 patients,with the success rate of 99. 0％ . There were 94 boys and 102 girls with the median age of (8. 7 ± 3. 7)years old(ranged 1. 1 - 16. 8 years old) at time of procedure. Indications included pancreatic diseases(156 cases)and bile duct diseases(40 cases). The ERCP findings were classified as followschronic pancreatitis(114 cases),acute recurrent pancreatitis(28 cases),bile duct stone(19 cases),acute pancreatitis(12 cases),cholangiectasis(8 cases),cholangitis(5 cases),congenital biliary dila-tion(5 cases)and other pancreaticobiliary. Furthermore,45. 9％ of the patients were proved to have structural abnor-malities after operation. The most common bile duct diseases were malfusion of pancreatobiliary ducts(60. 0％),and pancreas cleavage was the most common cause of recurrent pancreatitis,accounting for 22. 4％ . The total post - ERCP complication rate was 14. 3％,including 41 cases(13. 0％)mild to moderate post - ERCP pancreatitis,4 cases(1. 3％) gastrointestinal bleeding. All cases were cured by medical treatment except that one cases with duodenal minor papilla wound bleeding underwent emergent endoscopic hemostasis. No other serious complications occurred such as bile duct in-fection,postoperative perforation and severe pancreatitis related to ERCP. Statistical analysis showed that multiple repeated operations were the protective factor for post - ERCP pancreatitis and pancreatic stone removal was the risk factor. Conclusions The diagnostic and therapeutic utility of ERCP for pediatrics with pancreaticobiliary diseases is effective and safe.