Endoscopic Retrograde Cholangiopancreatography in Bangladeshi Children: Experiences and Challenges in a Developing Country.

Purpose: Although endoscopic retrograde cholangiopancreatography (ERCP) has been used for more than five decades, its applicability in Bangladeshi children has recently become more common. Therefore, this manuscript aims to describe our experience in performing ERCPs in Bangladeshi children with hepatopancreaticobiliary diseases, focusing on presenting diseases, as well as the diagnostic and therapeutic efficacy. Methods: Between 2018 and 2021, 20 children underwent 30 ERCP procedures at the Bangladesh Specialized Hospital, Dhaka. A single trained adult gastroenterologist performed all procedures using a therapeutic video duodenoscope. The indications for ERCP, diagnostic findings, therapeutic procedures, and complications were documented. Results: The median age of the study patients was 10 years (range, 1.7-15 years). Successful cannulation of the papilla was achieved in 28 procedures and failed in 2 cases. Repeated ERCP was required in seven patients. Nine patients had biliary indications and 11 had pancreatic indications. Choledocholithiasis was the most common indication for ERCP in patients with biliary disease, while chronic pancreatitis was common among patients with pancreatic indications. Pancreatic divisum was observed in only one patient. Pancreatic and biliary sphincterotomy was performed in 14 and 9 cases, respectively. A single pigtail or straight therapeutic stent was inserted in seven cases and removed in five cases. Stone extraction was performed in six procedures, and balloon dilatation was performed in five procedures. The post-procedural period for these patients was uneventful. Conclusion: We found that ERCP is a practical and successful therapeutic intervention for treating hepatopancreaticobiliary disorders in children when performed by experienced endoscopists.

Congenital Chylous Ascites: A Rare Cause of Infantile Ascites Treated With MCT-Based Diet and Octreotide.

Congenital chylous ascites (CCAs) are a rare disease that results from the accumulation of chylomicron-rich lymphatic fluid within the peritoneal cavity due to maldevelopment of the intra-abdominal lymphatic system. Medium-chain triglyceride (MCT)-based diet, total parenteral nutrition (TPN), and repeated paracentesis are considered supportive management for CCA. Cases unresponsive to conservative treatment usually require surgical intervention. We report a case of CCA in a premature neonate treated successfully with intravenous infusion of octreotide (synthetic somatostatin analog), after failing to respond to supportive therapies. Due to the lack of standards in diagnosis and treatment, this disease constitutes a medical challenge, and individual therapy seems to be noteworthy.